Tolonen N, Forsblom C, Thorn L, Wadén J, Rosengård-Bärlund M, Saraheimo M, Heikkilä O, Pettersson-Fernholm K, Taskinen M-R, Groop P-H
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki (C318b), University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014, Helsinki, Finland.
Diabetologia. 2008 Jan;51(1):12-20. doi: 10.1007/s00125-007-0858-y. Epub 2007 Nov 10.
AIMS/HYPOTHESIS: We studied the relationship between the lipid profile, estimated GFR (eGFR) and AER in patients with type 1 diabetes. We also assessed the association between the lipid profile and glycaemic control, obesity and hypertension in an environment free of manifest renal disease, as well as exploring how well the patients would have achieved the targets set in international guidelines.
A total of 2,927 adult patients who had type 1 diabetes and for whom lipid profiles were available were included from people participating in the nationwide, multicentre Finnish Diabetic Nephropathy Study (FinnDiane). eGFR was determined using the Cockcroft-Gault formula adjusted for body surface area.
Patients with impaired renal function (eGFR <60 ml min(-1) 1.73 m(-2)) had higher total cholesterol, triacylglycerol and apolipoprotein B, and lower HDL-cholesterol concentrations than patients with normal renal function (eGFR >90 ml min(-1) 1.73 m(-2)) or mildly impaired renal function (eGFR 60-90 ml min(-1) 1.73 m(-2)) (p < 0.001 for all associations). In type 1 diabetic patients without manifest renal disease, similar adverse lipid profiles could be observed in those who were overweight or obese and in those who had intermediate or poor glycaemic control or hypertension. In all the different patient groups 14 to 43% would have achieved the recommended target of <2.6 mmol/l for LDL-cholesterol.
CONCLUSIONS/INTERPRETATION: Multiple lipid abnormalities are not only present in type 1 diabetic patients with an abnormal AER, but also in those with impaired renal function. In patients without manifest renal disease, obesity, glycaemic control or hypertension were associated with an adverse lipid profile. A substantial number of patients studied would have exceeded the targets set by international guidelines, particularly the targets for LDL-cholesterol.
目的/假设：我们研究了1型糖尿病患者的血脂谱、估算肾小球滤过率（eGFR）与尿白蛋白排泄率（AER）之间的关系。我们还评估了在无明显肾脏疾病的情况下，血脂谱与血糖控制、肥胖和高血压之间的关联，并探讨了患者达到国际指南设定目标的情况。
从参与全国性多中心芬兰糖尿病肾病研究（FinnDiane）的人群中纳入了2927例患有1型糖尿病且有血脂谱数据的成年患者。使用根据体表面积调整的Cockcroft-Gault公式测定eGFR。
与肾功能正常（eGFR>90 ml·min⁻¹·1.73 m⁻²）或轻度肾功能受损（eGFR 60-90 ml·min⁻¹·1.73 m⁻²）的患者相比，肾功能受损（eGFR<60 ml·min⁻¹·1.73 m⁻²）的患者总胆固醇、三酰甘油和载脂蛋白B水平更高，高密度脂蛋白胆固醇浓度更低（所有关联的p<0.001）。在无明显肾脏疾病的1型糖尿病患者中，超重或肥胖、血糖控制中等或较差以及患有高血压的患者也观察到类似的不良血脂谱。在所有不同患者组中，14%至43%的患者将达到低密度脂蛋白胆固醇<2.6 mmol/l的推荐目标。
结论/解读：多种脂质异常不仅存在于AER异常的1型糖尿病患者中，也存在于肾功能受损的患者中。在无明显肾脏疾病的患者中，肥胖、血糖控制或高血压与不良血脂谱相关。大量研究患者会超过国际指南设定的目标，尤其是低密度脂蛋白胆固醇的目标。
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