Solbu Marit Dahl, Jenssen Trond G, Eriksen Bjørn O, Toft Ingrid
Department of Nephrology, University Hospital of North Norway, N-9038 Tromsø, Norway.
Metabolism. 2009 Mar;58(3):408-15. doi: 10.1016/j.metabol.2008.10.016.
Microalbuminuria (MA) clusters with the metabolic syndrome and insulin resistance and may reflect endothelial dysfunction. Microalbuminuria may also represent renal dysfunction. The aim of the present follow-up study was to assess changes over 13 years in insulin sensitivity, markers of endothelial dysfunction, and renal function in hypertensive subjects with and without MA in 1992-1993, matched for age, sex, and body mass index. Fourteen subjects with and 17 without MA at baseline (1992-1993) participated. At follow-up (2005-2006), MA status was unchanged in 75% of the subjects. The groups had comparable age, blood pressure, body mass index, markers of endothelial dysfunction, and metabolic traits, assessed by oral glucose tolerance test and hyperglycemic clamp. Estimated glomerular filtration rate decreased significantly in the MA group (P = .049) and tended to be lower in the MA than the non-MA group in 2005-2006 (79.9 +/- 24.5 vs 90.8 +/- 13.3 mL min(-1) (1.73 m(2))(-1), P = .2). Urinary albumin excretion in 1992-1993 predicted estimated glomerular filtration rate in 2005-2006 in adjusted analysis (beta = -0.47, P = .006). Estimated glomerular filtration rate less than 60 mL min(-1) (1.73 m(2))(-1) was more frequent in the MA than non-MA group at follow-up (P = .03). In conclusion, long-standing MA was not associated with progression of metabolic disturbances or markers of endothelial dysfunction in hypertensive individuals. A decline in renal function predicted by urinary albumin excretion was suggested. Microalbuminuria may not be a metabolic trait, but a marker mainly of renal endothelial dysfunction.
微量白蛋白尿（MA）与代谢综合征及胰岛素抵抗聚集在一起，可能反映内皮功能障碍。微量白蛋白尿也可能代表肾功能障碍。本随访研究的目的是评估1992 - 1993年年龄、性别和体重指数相匹配的有或无MA的高血压患者13年间胰岛素敏感性、内皮功能障碍标志物及肾功能的变化。14名基线时（1992 - 1993年）有MA和17名无MA的受试者参与了研究。随访时（2005 - 2006年），75%的受试者MA状态未改变。通过口服葡萄糖耐量试验和高血糖钳夹评估，两组在年龄、血压、体重指数、内皮功能障碍标志物及代谢特征方面具有可比性。MA组的估计肾小球滤过率显著下降（P = 0.049），且在2005 - 2006年MA组的估计肾小球滤过率有低于非MA组的趋势（79.9±24.5 vs 90.8±13.3 mL·min⁻¹·(1.73 m²)⁻¹，P = 0.2）。在调整分析中，1992 - 1993年的尿白蛋白排泄可预测2005 - 2006年的估计肾小球滤过率（β = -0.47，P = 0.006）。随访时，MA组估计肾小球滤过率低于60 mL·min⁻¹·(1.73 m²)⁻¹的情况比非MA组更常见（P = 0.03）。总之，长期MA与高血压个体的代谢紊乱进展或内皮功能障碍标志物无关。提示尿白蛋白排泄可预测肾功能下降。微量白蛋白尿可能不是一种代谢特征，而是主要反映肾内皮功能障碍的标志物。
