Pediatric, Adolescent & Young Adult Section, Joslin Diabetes Center, Boston, MA 02215, USA.
Diabet Med. 2010 May;27(5):532-7. doi: 10.1111/j.1464-5491.2010.02983.x.
To determine the occurrence of microalbuminuria in young people with Type 1 diabetes mellitus followed prospectively for 2 years and to relate the presence of persistent elevations in urinary albumin excretion (UAE) to age, diabetes duration, puberty and other factors.
During a 2 year period, random urine samples were obtained from 471 patients, aged 8-18 years (mean +/-sd 12.9 +/- 2.3 years) with Type 1 diabetes duration 5.6 +/- 3.0 years, as part of routine clinical care. Urine albumin and creatinine concentrations were measured in 1310 samples (median, 3 samples per patient) and the albumin:creatinine ratio was calculated (in micrograms albumin per milligram creatinine). Height, weight, blood pressure (BP), glycated haemoglobin (HbA(1c)), blood glucose monitoring frequency and Tanner staging were collected from patients' medical records.
Twenty-three per cent of patients had one or more sample with elevated UAE (> or =20 microg/mg) and 9.3% had persistent elevations (> or =2 samples > or =20 microg/mg). Those with and without persistent microalbuminuria did not differ significantly in age, diabetes duration, z-score for body mass index, pubertal status or BP percentile. Ten per cent of children <13 years old and 9% of children > or =13 years old had persistent microalbuminuria. Persistent microalbuminuria was significantly associated with diabetes duration only in older children (duration 0.5-3 years, 4%; 4-6 years, 8%; > or =7 years, 14%; P = 0.02, trend test). Mean HbA(1c) over the 2 years was 8.7 +/- 1.2%. In a logistic regression model, mean HbA(1c) was the only significant predictor of persistent microalbuminuria (odds ratio 1.3, 95% confidence interval 1.0-1.6, P = 0.05).
Microalbuminuria in older children with Type 1 diabetes is likely to be clinically significant. In younger children, it may reflect functional, reversible renal changes. Longitudinal analysis is needed to confirm the probable transient nature of microalbuminuria in young patients with Type 1 diabetes.
确定前瞻性随访 2 年后 1 型糖尿病患者微量白蛋白尿的发生情况，并将持续升高的尿白蛋白排泄率（UAE）与年龄、糖尿病病程、青春期及其他因素联系起来。
在 2 年期间，作为常规临床护理的一部分，从 471 名年龄在 8-18 岁（平均 12.9 +/- 2.3 岁）、1 型糖尿病病程 5.6 +/- 3.0 年的患者中随机采集尿液样本。对 1310 个样本（中位数，每个患者 3 个样本）中的尿白蛋白和肌酐浓度进行了测量，并计算了白蛋白：肌酐比值（以微克白蛋白/毫克肌酐表示）。从患者病历中收集了身高、体重、血压（BP）、糖化血红蛋白（HbA1c）、血糖监测频率和 Tanner 分期。
23%的患者有一个或多个 UAE 升高的样本（>或=20 微克/毫克），9.3%的患者有持续升高的 UAE（>或=2 个样本>或=20 微克/毫克）。持续性微量白蛋白尿患者与无持续性微量白蛋白尿患者在年龄、糖尿病病程、体重指数 z 评分、青春期状态或血压百分位等方面无显著差异。10%的<13 岁儿童和 9%的≥13 岁儿童有持续性微量白蛋白尿。持续性微量白蛋白尿仅与年龄较大的儿童（病程 0.5-3 年，4%；4-6 年，8%；≥7 年，14%；P = 0.02，趋势检验）显著相关。2 年期间的平均 HbA1c 为 8.7 +/- 1.2%。在逻辑回归模型中，平均 HbA1c 是持续性微量白蛋白尿的唯一显著预测因素（比值比 1.3，95%置信区间 1.0-1.6，P = 0.05）。
1 型糖尿病年龄较大的儿童微量白蛋白尿可能具有临床意义。在年幼的儿童中，它可能反映了功能性、可逆的肾脏变化。需要进行纵向分析来确认 1 型糖尿病年轻患者微量白蛋白尿的短暂性质。
