de Boer Ian H, Rue Tessa C, Cleary Patricia A, Lachin John M, Molitch Mark E, Steffes Michael W, Sun Wanjie, Zinman Bernard, Brunzell John D, White Neil H, Danis Ronald P, Davis Matthew D, Hainsworth Dean, Hubbard Larry D, Nathan David M
Kidney Research Institute and Division of Nephrology, University of Washington, Campus Box 359606, 325 Ninth Ave, Seattle, WA 98104, USA.
Arch Intern Med. 2011 Mar 14;171(5):412-20. doi: 10.1001/archinternmed.2011.16.
Microalbuminuria is a common diagnosis in the clinical care of patients with type 1 diabetes mellitus. Long-term outcomes after the development of microalbuminuria are variable.
We quantified the incidence of and risk factors for long-term renal outcomes after the development of microalbuminuria in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. The DCCT randomly assigned 1441 persons with type 1 diabetes to intensive or conventional diabetes therapy, and participants were subsequently followed up during the observational EDIC study. During the DCCT/EDIC study, 325 participants developed incident persistent microalbuminuria (albumin excretion rate, ≥30 mg/24 h at 2 consecutive study visits). We assessed their subsequent renal outcomes, including progression to macroalbuminuria (albumin excretion rate, ≥300 mg/24 h at 2 consecutive visits), impaired glomerular filtration rate (estimated glomerular filtration rate, <60 mL/min/1.73 m(2) at 2 consecutive study visits), end-stage renal disease, and regression to normoalbuminuria (albumin excretion rate, <30 mg/24 h at 2 consecutive visits).
The median follow-up period after persistent microalbuminuria diagnosis was 13 years (maximum, 23 years). Ten-year cumulative incidences of progression to macroalbuminuria, impaired glomerular filtration rate, end-stage renal disease, and regression to normoalbuminuria were 28%, 15%, 4%, and 40%, respectively. Albuminuria outcomes were more favorable with intensive diabetes therapy, lower glycated hemoglobin level, absence of retinopathy, female sex, lower blood pressure, and lower concentrations of low-density lipoprotein cholesterol and triglycerides. Lower glycated hemoglobin level, absence of retinopathy, and lower blood pressure were also associated with decreased risk of impaired glomerular filtration rate.
After the development of persistent microalbuminuria, progression and regression of kidney disease each commonly occur. Intensive glycemic control, lower blood pressure, and a more favorable lipid profile are associated with improved outcomes.
微量白蛋白尿是1型糖尿病患者临床护理中的常见诊断。微量白蛋白尿出现后的长期预后各不相同。
我们在糖尿病控制与并发症试验/糖尿病干预与并发症流行病学（DCCT/EDIC）研究中，对微量白蛋白尿出现后长期肾脏预后的发生率和危险因素进行了量化。DCCT将1441例1型糖尿病患者随机分为强化糖尿病治疗组或传统糖尿病治疗组，随后在观察性EDIC研究中对参与者进行随访。在DCCT/EDIC研究期间，325名参与者出现了持续性微量白蛋白尿（连续2次研究访视时白蛋白排泄率≥30mg/24小时）。我们评估了他们随后的肾脏预后，包括进展为大量白蛋白尿（连续2次访视时白蛋白排泄率≥300mg/24小时）、肾小球滤过率受损（连续2次研究访视时估计肾小球滤过率<60mL/min/1.73m²）、终末期肾病以及恢复至正常白蛋白尿（连续2次访视时白蛋白排泄率<30mg/24小时）。
持续性微量白蛋白尿诊断后的中位随访期为13年（最长23年）。进展为大量白蛋白尿、肾小球滤过率受损、终末期肾病以及恢复至正常白蛋白尿的10年累积发生率分别为28%、15%、4%和40%。强化糖尿病治疗、较低的糖化血红蛋白水平、无视网膜病变、女性、较低的血压以及较低的低密度脂蛋白胆固醇和甘油三酯浓度，白蛋白尿预后更有利。较低的糖化血红蛋白水平、无视网膜病变以及较低的血压也与肾小球滤过率受损风险降低相关。
持续性微量白蛋白尿出现后，肾脏疾病的进展和恢复均较为常见。强化血糖控制、降低血压以及更有利的血脂谱与改善预后相关。
