Araki Shin-ichi, Haneda Masakazu, Koya Daisuke, Hidaka Hideki, Sugimoto Toshiro, Isono Motohide, Isshiki Keiji, Chin-Kanasaki Masami, Uzu Takashi, Kashiwagi Atsunori
Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
Diabetes. 2007 Jun;56(6):1727-30. doi: 10.2337/db06-1646. Epub 2007 Mar 14.
Microalbuminuria in diabetic patients is a predictor for diabetic nephropathy and cardiovascular disease. The aim of this study is to investigate the clinical impact of reducing microalbuminuria in type 2 diabetic patients in an observational follow-up study.
We enrolled 216 type 2 diabetic patients with microalbuminuria during an initial 2-year evaluation period and observed them for the next 8 years. Remission and a 50% reduction of microalbuminuria were defined as a shift to normoalbuminuria and a reduction <50% from the initial level of microalbuminuria. The association between reducing microalbuminuria and first occurrence of a renal or cardiovascular event and annual decline rate of estimated glomerular filtration rate (eGFR) was evaluated.
Twelve events occurred in 93 patients who attained a 50% reduction of microalbuminuria during the follow-up versus 35 events in 123 patients without a 50% reduction. The cumulative incidence rate of events was significantly lower in patients with a 50% reduction. A pooled logistic regression analysis revealed that the adjusted risk for events in subjects after a 50% reduction was 0.41 (95% CI 0.15-0.96). In addition, the annual decline rate of eGFR in patients with a 50% reduction was significantly slower than in those without such a reduction. The same results were also found in the analysis regarding whether remission occurred.
The present study provides clinical evidence implying that a reduction of microalbuminuria in type 2 diabetic patients is an integrated indicator for renal and cardiovascular risk reduction.
糖尿病患者的微量白蛋白尿是糖尿病肾病和心血管疾病的预测指标。本研究的目的是在一项观察性随访研究中调查降低2型糖尿病患者微量白蛋白尿的临床影响。
我们纳入了216例在初始2年评估期内有微量白蛋白尿的2型糖尿病患者，并在接下来的8年中对他们进行观察。微量白蛋白尿的缓解和降低50%被定义为转变为正常白蛋白尿以及较微量白蛋白尿初始水平降低<50%。评估了降低微量白蛋白尿与首次发生肾脏或心血管事件以及估计肾小球滤过率（eGFR）的年下降率之间的关联。
在随访期间微量白蛋白尿降低50%的93例患者中发生了12起事件，而在未降低50%的123例患者中发生了35起事件。微量白蛋白尿降低50%的患者事件累积发生率显著更低。一项汇总逻辑回归分析显示，降低50%后的受试者事件调整风险为0.41（95%CI 0.15 - 0.96）。此外，微量白蛋白尿降低50%的患者eGFR的年下降率明显慢于未降低的患者。在关于是否发生缓解的分析中也发现了相同的结果。
本研究提供了临床证据，表明降低2型糖尿病患者的微量白蛋白尿是降低肾脏和心血管风险的综合指标。
