Jones S L, Close C F, Mattock M B, Jarrett R J, Keen H, Viberti G C
Unit for Metabolic Medicine, United Medical School, Guy's Hospital, London.
BMJ. 1989 Feb 25;298(6672):487-90. doi: 10.1136/bmj.298.6672.487.
To determine whether insulin dependent diabetics with microalbuminuria have significant abnormalities in concentrations of lipoproteins, apolipoproteins AI and B, fibrinogen, and clotting factor VII which could result in increased cardiovascular risk.
Case-control study.
Outpatient department of a metabolic ward.
Group of 20 insulin dependent diabetics with urinary albumin excretion rates greater than 30 micrograms/min (microalbuminuria) and 20 individually matched insulin dependent diabetics with normal urinary albumin excretion rates (below 30 micrograms/min) matched for age, sex, and duration of diabetes.
Fasting venous blood samples were taken for determination of concentrations of glucose, glycated haemoglobin, lipoproteins, apolipoproteins AI and B, fibrinogen, and factor VII. Height, weight, arterial pressure, and usual insulin dose were recorded, and each patient was given a dietary questionnaire to be completed at home.
Comparison of blood pressure and concentrations of lipoproteins, apolipoproteins AI and B, and fibrinogen in the diabetics with microalbuminuria and the controls.
Patients with microalbuminuria had significantly higher concentrations of low density lipoprotein cholesterol (mean 3.33 (SE 0.20) v 2.84 (0.12) mmol/l) and very low density lipoprotein cholesterol (0.30 (0.05) v 0.17 (0.03) mmol/l) than controls but significantly lower concentrations of high density lipoprotein 2 subfraction cholesterol (0.32 (0.04) v 0.54 (0.04) mmol/l). Concentrations of total triglyceride (1.11 (0.14) v 0.68 (0.08) mmol/l), very low density lipoprotein triglyceride (0.56 (0.10) v 0.30 (0.05) mmol/l), apolipoprotein B (0.88 (0.06) v 0.67 (0.03) g/l) and fibrinogen (2.2 (0.1) v 1.9 (0.1) g/l), and diastolic arterial pressure (80 (2) v 74 (2) mm Hg), were also higher in patients with microalbuminuria.
Cardiovascular risk factors--namely, disturbances in lipoprotein and apolipoprotein concentrations, increased fibrinogen concentration, and increased arterial pressure--are already present in insulin dependent diabetics with microalbuminuria. The increased risk of coronary heart disease in patients with clinical proteinuria may result from prolonged exposure to these risk factors, which are present before any impairment of renal function.
确定伴有微量白蛋白尿的胰岛素依赖型糖尿病患者在脂蛋白、载脂蛋白AI和B、纤维蛋白原及凝血因子VII浓度方面是否存在显著异常，这些异常是否会导致心血管疾病风险增加。
病例对照研究。
代谢病房门诊。
20例尿白蛋白排泄率大于30微克/分钟（微量白蛋白尿）的胰岛素依赖型糖尿病患者，以及20例年龄、性别和糖尿病病程相匹配的尿白蛋白排泄率正常（低于30微克/分钟）的胰岛素依赖型糖尿病患者。
采集空腹静脉血样本，测定血糖、糖化血红蛋白、脂蛋白、载脂蛋白AI和B、纤维蛋白原及因子VII的浓度。记录身高、体重、动脉血压和常规胰岛素剂量，每位患者都收到一份饮食问卷，要求在家中完成。
比较微量白蛋白尿糖尿病患者与对照组的血压、脂蛋白、载脂蛋白AI和B及纤维蛋白原浓度。
微量白蛋白尿患者的低密度脂蛋白胆固醇浓度（平均3.33（标准误0.20）对2.84（0.12）毫摩尔/升）和极低密度脂蛋白胆固醇浓度（0.30（0.05）对0.17（0.03）毫摩尔/升）显著高于对照组，但高密度脂蛋白2亚组分胆固醇浓度（0.32（0.04）对0.54（0.04）毫摩尔/升）显著低于对照组。微量白蛋白尿患者的总甘油三酯浓度（1.11（0.14）对0.68（0.08）毫摩尔/升）、极低密度脂蛋白甘油三酯浓度（0.56（0.10）对0.30（0.05）毫摩尔/升）、载脂蛋白B（0.88（0.06）对0.67（0.03）克/升）、纤维蛋白原（2.2（0.1）对1.9（0.1）克/升）及舒张压（80（2）对74（2）毫米汞柱）也较高。
伴有微量白蛋白尿的胰岛素依赖型糖尿病患者已存在心血管疾病危险因素，即脂蛋白和载脂蛋白浓度紊乱、纤维蛋白原浓度升高及动脉血压升高。临床蛋白尿患者冠心病风险增加可能是由于长期暴露于这些在肾功能损害之前就已存在的危险因素。
