Ninomiya Toshiharu, Perkovic Vlado, de Galan Bastiaan E, Zoungas Sophia, Pillai Avinesh, Jardine Meg, Patel Anushka, Cass Alan, Neal Bruce, Poulter Neil, Mogensen Carl-Erik, Cooper Mark, Marre Michel, Williams Bryan, Hamet Pavel, Mancia Giuseppe, Woodward Mark, Macmahon Stephen, Chalmers John
George Institute for International Health, University of Sydney, Sydney, NSW, Australia.
J Am Soc Nephrol. 2009 Aug;20(8):1813-21. doi: 10.1681/ASN.2008121270. Epub 2009 May 14.
There are limited data regarding whether albuminuria and reduced estimated GFR (eGFR) are separate and independent risk factors for cardiovascular and renal events among individuals with type 2 diabetes. The Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study examined the effects of routine BP lowering on adverse outcomes in type 2 diabetes. We investigated the effects of urinary albumin-to-creatinine ratio (UACR) and eGFR on the risk for cardiovascular and renal events in 10,640 patients with available data. During an average 4.3-yr follow-up, 938 (8.8%) patients experienced a cardiovascular event and 107 (1.0%) experienced a renal event. The multivariable-adjusted hazard ratio for cardiovascular events was 2.48 (95% confidence interval 1.74 to 3.52) for every 10-fold increase in baseline UACR and 2.20 (95% confidence interval 1.09 to 4.43) for every halving of baseline eGFR, after adjustment for regression dilution. There was no evidence of interaction between the effects of higher UACR and lower eGFR. Patients with both UACR >300 mg/g and eGFR <60 ml/min per 1.73 m(2) at baseline had a 3.2-fold higher risk for cardiovascular events and a 22.2-fold higher risk for renal events, compared with patients with neither of these risk factors. In conclusion, high albuminuria and low eGFR are independent risk factors for cardiovascular and renal events among patients with type 2 diabetes.
关于在2型糖尿病患者中，蛋白尿和估算肾小球滤过率（eGFR）降低是否是心血管和肾脏事件的独立风险因素，相关数据有限。糖尿病和血管疾病行动：百普乐与美卡素对照评估（ADVANCE）研究，考察了常规降压对2型糖尿病不良结局的影响。我们对10640例有可用数据的患者，研究了尿白蛋白与肌酐比值（UACR）和eGFR对心血管和肾脏事件风险的影响。在平均4.3年的随访期间，938例（8.8%）患者发生了心血管事件，107例（1.0%）发生了肾脏事件。在校正回归稀释后，基线UACR每增加10倍，心血管事件的多变量校正风险比为2.48（95%置信区间1.74至3.52）；基线eGFR每减半，心血管事件的多变量校正风险比为2.20（95%置信区间1.09至4.43）。较高UACR和较低eGFR的作用之间没有交互作用的证据。与无这两种风险因素的患者相比，基线时UACR>300mg/g且eGFR<60ml/min per 1.73m²的患者，发生心血管事件的风险高3.2倍，发生肾脏事件的风险高22.2倍。总之，高蛋白尿和低eGFR是2型糖尿病患者心血管和肾脏事件的独立风险因素。
