Ponder S W, Brouhard B H, Travis L B
Department of Pediatrics, Cleveland Clinic Foundation, Ohio.
Diabetes Care. 1990 Apr;13(4):437-41. doi: 10.2337/diacare.13.4.437.
Urinary excretion of calcium, inorganic phosphorus, magnesium, glucose, and creatinine was measured in first-void spot urine samples collected 4 days apart in 220 insulin-dependent diabetic (IDDM) children (mean age 11.9 yr) attending a summer camp. A single control urine sample was obtained from 33 healthy nondiabetic siblings (mean age 11.2 yr). Mean +/- SD urinary calcium-creatinine ratios (UCa/Cr) did not significantly differ between IDDM and control subjects (0.14 +/- 0.09 vs. 0.12 +/- 0.09, respectively, P = 0.156). Mean urinary magnesium-creatinine ratios (UMg/Cr) were elevated in IDDM compared with control subjects (0.15 +/- 0.06 vs. 0.08 +/- 0.03, respectively, P = 0.0001). Similarly, mean urinary phosphorus-creatinine ratios (UP/Cr) were significantly increased over those in control subjects (1.12 +/- 0.33 vs. 0.40 +/- 0.22, respectively, P = 0.0001). UCa/Cr, UMg/Cr, and UP/Cr were correlated with increasing mean urine glucose content (P = 0.0001). No correlations were found when UCa/Cr, UMg/Cr, or UP/Cr were compared with patient age, duration of diabetes, glycosylated hemoglobin, or insulin dosage. Urine losses of phosphorus and magnesium were present even when glycemic control was considered good by several methods (glycosylated hemoglobin, short-term glycemic index, or urinary glucose content). Glomerular hyperfiltration was unable to account for increased urinary mineral content. In conclusion, the data indicate that urinary excretion of phosphorus and magnesium is elevated in children with IDDM, regardless of glycemic control. In the presence of glucosuria, this loss is further enhanced. Urinary calcium excretion is significantly higher only during periods of glucosuria. The data suggest that children with IDDM could be at risk for mineral deficiencies in the absence of intensive insulin management.
在参加夏令营的220名胰岛素依赖型糖尿病（IDDM）儿童（平均年龄11.9岁）中，每隔4天收集首次晨尿样本，测量其中钙、无机磷、镁、葡萄糖和肌酐的尿排泄量。从33名健康的非糖尿病同胞（平均年龄11.2岁）中获取一份对照尿样。IDDM患者与对照受试者的平均尿钙肌酐比值（UCa/Cr）（分别为0.14±0.09和0.12±0.09）无显著差异（P = 0.156）。与对照受试者相比，IDDM患者的平均尿镁肌酐比值（UMg/Cr）升高（分别为0.15±0.06和0.08±0.03，P = 0.0001）。同样，平均尿磷肌酐比值（UP/Cr）也显著高于对照受试者（分别为1.12±0.33和0.40±0.22，P = 0.0001）。UCa/Cr、UMg/Cr和UP/Cr与平均尿葡萄糖含量增加相关（P = 0.0001）。当将UCa/Cr、UMg/Cr或UP/Cr与患者年龄、糖尿病病程、糖化血红蛋白或胰岛素剂量进行比较时，未发现相关性。即使通过几种方法（糖化血红蛋白、短期血糖指数或尿葡萄糖含量）认为血糖控制良好，仍存在磷和镁的尿丢失。肾小球高滤过无法解释尿矿物质含量的增加。总之，数据表明，无论血糖控制如何，IDDM儿童的磷和镁尿排泄量都会升高。在存在糖尿的情况下，这种丢失会进一步加剧。仅在糖尿期间尿钙排泄量显著更高。数据表明，在缺乏强化胰岛素治疗的情况下，IDDM儿童可能存在矿物质缺乏的风险。
