Marshall S M, Alberti K G
Department of Medicine, University of Newcastle upon Tyne.
Q J Med. 1989 Jan;70(261):61-71.
Overnight albumin excretion rates were measured in 940 diabetic patients, 416 with insulin dependent and 524 with non-insulin dependent diabetes, and in 106 healthy volunteers. A significantly higher number of non-insulin dependent diabetic patients had abnormal albumin excretion compared with the insulin-dependent group (X2 = 15.2, p less than 0.002). Ten per cent of non-insulin-dependent and 7 per cent of insulin-dependent diabetic patients had albumin excretion rates in the range 30-150 micrograms/min and thus were at risk of the cardiovascular and renal complications of diabetes. Six per cent of non-insulin-dependent and 5 per cent of insulin-dependent diabetic patients had albumin excretion rates above 150 micrograms/min and thus were entering the phase of clinical diabetic nephropathy. Multivariate analysis revealed that male sex and retinopathy in insulin-dependent diabetes, and systolic blood pressure and retinopathy and peripheral vascular disease in non-insulin-dependent diabetes, were significantly related to albumin excretion. Only one patient with insulin-dependent diabetes of less than 5 years known duration had an albumin excretion rate in the range 30-150 micrograms/min, whereas such an excretion rate indicating patients at risk was observed at all durations of non-insulin-dependent diabetes. It is possible that during the long silent phase of non-insulin-dependent diabetes, before diagnosis, significant renal damage occurred.
对940例糖尿病患者（416例胰岛素依赖型和524例非胰岛素依赖型）以及106名健康志愿者测定了夜间白蛋白排泄率。与胰岛素依赖型组相比，非胰岛素依赖型糖尿病患者中白蛋白排泄异常者显著增多（X2 = 15.2，p＜0.002）。10%的非胰岛素依赖型糖尿病患者和7%的胰岛素依赖型糖尿病患者白蛋白排泄率在30 - 150微克/分钟范围内，因此有发生糖尿病心血管和肾脏并发症的风险。6%的非胰岛素依赖型糖尿病患者和5%的胰岛素依赖型糖尿病患者白蛋白排泄率高于150微克/分钟，因此已进入临床糖尿病肾病阶段。多因素分析显示，胰岛素依赖型糖尿病中的男性和视网膜病变，以及非胰岛素依赖型糖尿病中的收缩压、视网膜病变和外周血管疾病，均与白蛋白排泄显著相关。已知病程小于5年的胰岛素依赖型糖尿病患者中，只有1例白蛋白排泄率在30 - 150微克/分钟范围内，而在非胰岛素依赖型糖尿病的所有病程中均观察到这种提示有风险的排泄率。在非胰岛素依赖型糖尿病诊断前的漫长无症状期内，有可能发生了显著的肾脏损害。
