正常白蛋白尿性肾功能不全的糖尿病患者：一个低风险群体。
Normoalbuminuric renal-insufficient diabetic patients: a lower-risk group.
作者信息
Rigalleau Vincent, Lasseur Catherine, Raffaitin Christelle, Beauvieux Marie-Christine, Barthe Nicole, Chauveau Philippe, Combe Christian, Gin Henri
机构信息
Department of Nutrition-Diabétologie, Hôpital Haut-Lévêque, Avenue de Magellan, 33600 Pessac, France.
出版信息
Diabetes Care. 2007 Aug;30(8):2034-9. doi: 10.2337/dc07-0140. Epub 2007 May 7.
OBJECTIVE
About 20% of diabetic patients with chronic kidney disease (CKD) detected from the new American Diabetes Association recommendations (albumin excretion rate >30 mg/24 h or estimated glomerular filtration rate [GFR] <60 ml/min per 1.73 m2) may be normoalbuminuric. Do the characteristics and outcome differ for subjects with and without albuminuria?
RESEARCH DESIGN AND METHODS
A total of 89 patients with diabetes and a modification of diet in renal disease (MDRD) estimated GFR (e-GFR) <60 ml/min per 1.73 m2 underwent a 51Cr-EDTA B-isotopic GFR determination and were followed up for 38 +/- 11 months.
RESULTS
The mean MDRD e-GFR (41.3 +/- 13.1 ml/min per 1.73 m2) did not significantly differ from the i-GFR (45.6 +/- 29.7). Of the subjects, 15 (17%) were normoalbuminuric. Their i-GFR did not differ from the albuminuric rate and from their MDRD e-GFR, although their serum creatinine was lower (122 +/- 27 vs. 160 +/- 71 micromol/l, P < 0.05): 71% would not have been detected by measuring serum creatinine (sCr) alone. They were less affected by diabetic retinopathy, and their HDL cholesterol and hemoglobin were higher (P < 0.05 vs. albuminuric). None of the CKD normoalbuminuric subjects started dialysis (microalbuminuric: 2/36, macroalbuminuric: 10/38) or died (microalbuminuric: 3/36, macroalbuminuric: 7/38) during the follow-up period (log-rank test: P < 0.005 for death or dialysis), and their albumin excretion rate and sCr values were stable after 38 months, whereas the AER increased in the microalbuminuric patients (P < 0.05), and the sCr increased in the macroalbuminuric patients (P < 0.01).
CONCLUSIONS
Although their sCr is usually normal, most of the normoalbuminuric diabetic subjects with CKD according to an MDRD e-GFR below 60 ml/min per 1.73 m2 do really have a GFR below 60 ml/min per 1.73 m2. However, as expected, because of normoalbuminuria and other favorable characteristics, their risk for CKD progression or death is lower.
目的
根据美国糖尿病协会新指南检测出的慢性肾脏病（CKD）糖尿病患者中，约20%可能为正常白蛋白尿。有蛋白尿和无蛋白尿的患者在特征和预后方面是否存在差异？
研究设计与方法
共有89例糖尿病患者，其肾脏病饮食改良（MDRD）估算肾小球滤过率（e-GFR）<60 ml/（min·1.73 m²），接受了51Cr-EDTA B同位素GFR测定，并随访38±11个月。
结果
MDRD平均e-GFR（41.3±13.1 ml/（min·1.73 m²））与同位素测定的GFR（i-GFR，45.6±29.7）无显著差异。其中15例（17%）为正常白蛋白尿。他们的i-GFR与白蛋白尿患者以及MDRD e-GFR无差异，尽管其血清肌酐较低（122±27 vs. 160±71 μmol/L，P<0.05）：仅通过检测血清肌酐（sCr），71%的患者无法被检测出来。他们受糖尿病视网膜病变的影响较小，高密度脂蛋白胆固醇和血红蛋白水平较高（与白蛋白尿患者相比，P<0.05）。在随访期间，CKD正常白蛋白尿患者均未开始透析（微量白蛋白尿：2/36，大量白蛋白尿：10/38）或死亡（微量白蛋白尿：3/36，大量白蛋白尿：7/38）（对数秩检验：死亡或透析P<0.005），且38个月后其白蛋白排泄率和sCr值稳定，而微量白蛋白尿患者的AER升高（P<0.05），大量白蛋白尿患者的sCr升高（P<0.01）。
结论
尽管大多数根据MDRD e-GFR低于60 ml/（min·1.73 m²）诊断为CKD的正常白蛋白尿糖尿病患者的sCr通常正常，但他们的GFR确实低于60 ml/（min·1.73 m²）。然而，正如预期的那样，由于正常白蛋白尿和其他有利特征，他们CKD进展或死亡的风险较低。
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