Steffes M W, Mauer S M
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis 55455.
Clin Chem. 1991 Oct;37(10 Pt 2):1838-42.
In examining the pathophysiology underlying the development of hypertension in diabetes mellitus, it is important to draw clear distinctions between Type I and Type II diabetes. In patients with Type I diabetes, with a peak onset of disease early in the second decade of life, hypertension clearly represents the sequelae to the development of substantial renal lesions, especially in the glomerulus. Thus the prevalence of hypertension in those patients without substantial glomerular lesions approximates the incidence of hypertension in the general population (approximately 4%). In patients with Type II diabetes mellitus and onset generally later in adult life, an increase in blood pressure can often be demonstrated early after or even before diagnosis of the disease (most readily demonstrated in the Pima Indians). Furthermore, clear familial tendencies towards the development of nephropathic complications of diabetes can be shown. In patients with Type I disease, the fall in glomerular filtration rate parallels the fall in glomerular capillary surface available for filtration. This reduction in the peripheral glomerular capillary surface correlates well with the expansion of the mesangium, strongly implicating the mesangial expansion in the demise in renal function. For both Type I and Type II diabetes mellitus, the increase in albuminuria may reflect an opening of large pores in the glomerular basement membrane, thereby allowing serum proteins to cross into the filtration space.
在研究糖尿病患者高血压发生的病理生理学过程中，明确区分1型糖尿病和2型糖尿病非常重要。对于1型糖尿病患者，发病高峰在生命的第二个十年早期，高血压显然是严重肾脏病变尤其是肾小球病变发展的后遗症。因此，那些没有明显肾小球病变的患者中高血压的患病率接近普通人群中高血压的发病率（约4%）。对于2型糖尿病患者，发病通常在成年后期，在疾病诊断后甚至诊断前早期往往就能发现血压升高（在皮马印第安人中最容易表现出来）。此外，糖尿病肾病并发症的发生存在明显的家族倾向。在1型糖尿病患者中，肾小球滤过率的下降与可用于滤过的肾小球毛细血管表面积的下降平行。外周肾小球毛细血管表面积的这种减少与系膜扩张密切相关，有力地表明系膜扩张与肾功能下降有关。对于1型和2型糖尿病患者，蛋白尿的增加可能反映肾小球基底膜上大孔的开放，从而使血清蛋白进入滤过空间。
