Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taichung, Taiwan.
Eur J Clin Invest. 2011 Aug;41(8):870-8. doi: 10.1111/j.1365-2362.2011.02479.x. Epub 2011 Feb 8.
Asian has higher prevalence of diabetic nephropathy (DN) and end-stage renal disease when compared to Caucasian. No study to date has evaluated whether multifactorial intervention was associated with remission of microalbuminuria in type 2 diabetic Asian population. We evaluated the effect of tightly controlling multiple factors on the remission of DN in type 2 diabetic Chinese with microalbuminuria.
A longitudinal cohort study was collected 587 type 2 diabetic patients with microalbuminuria. Cohort members received intensified treatment to meet the following ADA recommended goals: HbA1c <7%, systolic blood pressure (SBP) <130mmHg, diastolic blood pressure <80 mmHg, low-density lipoprotein cholesterol <100mgdL(-1) , triglyceride < 150mgdL(-1) , high-density lipoprotein cholesterol >40mgdL(-1) for men and >50mgdL(-1) for women. Remission of microalbuminuria was defined as shift of albumin-creatinine ratio from mircoalbuminuria to normoalbuminuria.
During the 4·5-year period, 210 (35·8%) patients achieved remission to normoalbuminuria. A significant association was found between the achievement of ADA goals, including HbA1c < 7% [hazard ratio (HR)=1·345; 95% confidence interval (CI), 1·010-1·792; P=0·04] and SBP <130mmHg (HR, 1·516; 95% CI, 1·100-2·089; P=0·01) and remission of microalbuminuria. The intensive SBP control (<120mmHg) was significantly associated with remission of microalbuminuria (HR, 2·076; 95% CI, 1·347-3·198; P<0·001).
The remission of DN could be achieved under multifactorial intervention. Therapeutic focus on remission by tight glycemic and blood pressure control should be considered in Asian population with diabetes and microalbuminuria.
与白种人相比，亚洲人糖尿病肾病（DN）和终末期肾病的患病率更高。迄今为止，尚无研究评估多因素干预是否与 2 型糖尿病亚洲人群微量白蛋白尿的缓解相关。我们评估了严格控制多种因素对 2 型糖尿病伴微量白蛋白尿的中国人群 DN 缓解的影响。
一项纵向队列研究纳入了 587 名 2 型糖尿病伴微量白蛋白尿患者。队列成员接受强化治疗以达到以下 ADA 推荐目标：HbA1c<7%，收缩压（SBP）<130mmHg，舒张压<80mmHg，低密度脂蛋白胆固醇<100mg/dL（-1），甘油三酯<150mg/dL（-1），高密度脂蛋白胆固醇男性>40mg/dL（-1），女性>50mg/dL（-1）。微量白蛋白尿的缓解定义为白蛋白/肌酐比值从微量白蛋白尿转为正常白蛋白尿。
在 4.5 年期间，210 名（35.8%）患者达到正常白蛋白尿缓解。实现 ADA 目标（包括 HbA1c<7%[风险比（HR）=1.345；95%置信区间（CI），1.010-1.792；P=0.04]和 SBP<130mmHg（HR，1.516；95%CI，1.100-2.089；P=0.01）与微量白蛋白尿的缓解显著相关。强化 SBP 控制（<120mmHg）与微量白蛋白尿的缓解显著相关（HR，2.076；95%CI，1.347-3.198；P<0.001）。
多因素干预可实现 DN 的缓解。在伴有糖尿病和微量白蛋白尿的亚洲人群中，通过严格的血糖和血压控制来关注缓解，应作为一种治疗重点。
