Barri Yousri M, Palmer Biff F, Ram C Venkata S
Dallas Nephrology Associates, Dallas, TX 75204, USA.
Postgrad Med. 2005 Dec;118(6 Suppl Beta-Blockers):34-45. doi: 10.3810/pgm.12.2005.suppl43.230.
Microalbuminuria-increased urinary albumin excretion undetectable by traditional urinary dipstick-has been associated with insulin resistance, diabetes mellitus, obesity, and hypertension. It is also a powerful predictor for heart disease and all-cause mortality. In diabetic patients, microalbuminuria has been correlated with the progression of diabetic nephropathy and the development of renal insufficiency. Furthermore, its correlation with markers of inflammation such as C-reactive protein suggests that microalbuminuria may indicate generalized endothelial dysfunction rather than isolated nephropathy. Drugs that block the renin-angiotensin system, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown to reduce albuminuria, resulting in renal protection. Recently, dualaction beta-adrenergic blockers such as carvedilol have been shown to exert favorable effects on albuminuria in diabetic patients with hypertension. Insulin resistance reflects a predictable risk for diabetes, and there appears to be a good correlation between insulin resistance, albuminuria, and progression of renal disease in diabetes with or without hypertension. As in microalbuminuria, ACE inhibitors, ARBs, and dual-action beta-blockers help improve insulin sensitivity.
微量白蛋白尿——即通过传统尿试纸检测不到的尿白蛋白排泄增加——与胰岛素抵抗、糖尿病、肥胖症和高血压有关。它也是心脏病和全因死亡率的有力预测指标。在糖尿病患者中，微量白蛋白尿与糖尿病肾病的进展及肾功能不全的发生相关。此外，它与炎症标志物如C反应蛋白的相关性表明，微量白蛋白尿可能提示全身性内皮功能障碍，而非单纯的肾病。已证实，阻断肾素-血管紧张素系统的药物，如血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB），可减少蛋白尿，从而起到肾脏保护作用。最近，已证实卡维地洛等双重作用的β受体阻滞剂对患有高血压的糖尿病患者的蛋白尿有有益影响。胰岛素抵抗反映了发生糖尿病的可预测风险，在有或无高血压的糖尿病患者中，胰岛素抵抗、蛋白尿和肾病进展之间似乎存在良好的相关性。与微量白蛋白尿的情况一样，ACE抑制剂、ARB和双重作用的β受体阻滞剂有助于改善胰岛素敏感性。
