Zander E, Schulz B, Mester J, Jutzi E, Templin R, Conde N
Central Institute of Diabetes, Gerhardt Katsch, Karlsburg, German Democratic Republic.
J Diabet Complications. 1987 Apr-Jun;1(2):53-7. doi: 10.1016/s0891-6632(87)80080-6.
This study was designed to investigate the importance of risk factors such as hyperglycemia and elevated systolic and diastolic blood pressures on the progression of renal insufficiency in diabetics suffering from diabetic nephropathy. Seventeen patients with Type I, insulin-dependent diabetes mellitus (IDDM) (8 women and 9 men) undergoing chronic hemodialysis were investigated by retrospective follow-up and compared with 17 age and sex matched IDDM patients without diabetic nephropathy (controls). According to the time interval of creatinine increase from 200 to 600 mumol/l, the patients were divided arbitrarily into two groups with rapidly (group I less than 20 months) or slowly progressive (group II greater than or equal to 20 months) renal insufficiency. This period was 13.4 +/- 2.05 months in group I (age 36.67 +/- 2.47 years, diabetes duration 23.55 +/- 2.37 years) and 32.75 +/- 4.34 months in group II (age 40.62 +/- 2.63 years, diabetes duration 26.62 +/- 2.63 years, P.n.s.), respectively. The IDDM patients studied exhibited individually differing progressions of renal insufficiency at different times after manifestation of diabetes. After 15 years of diabetes duration, both risk factors, that is blood pressure and blood glucose concentrations, were elevated in nephropathic diabetics when compared with controls (p less than 0.01). During the phase of declining kidney function, mean blood pressures were found to be higher in IDDM patients with rapid progression of renal insufficiency when compared with slowly progressing diabetics. Although both risk factors were related to diabetic nephropathy, during the phase of renal insufficiency hypertension appeared to be more closely related to the further deterioration of kidney function.
本研究旨在调查高血糖、收缩压和舒张压升高这些风险因素对患有糖尿病肾病的糖尿病患者肾功能不全进展的重要性。通过回顾性随访对17例接受慢性血液透析的Ⅰ型胰岛素依赖型糖尿病（IDDM）患者（8名女性和9名男性）进行了研究，并与17名年龄和性别相匹配的无糖尿病肾病的IDDM患者（对照组）进行比较。根据肌酐从200升至600μmol/l的时间间隔，将患者任意分为两组，肾功能不全进展迅速组（Ⅰ组，小于20个月）和进展缓慢组（Ⅱ组，大于或等于20个月）。Ⅰ组这一时期为13.4±2.05个月（年龄36.67±2.47岁，糖尿病病程23.55±2.37年），Ⅱ组为32.75±4.34个月（年龄40.62±2.63岁，糖尿病病程26.62±2.63年，无显著性差异）。所研究的IDDM患者在糖尿病发病后的不同时间表现出个体不同的肾功能不全进展情况。糖尿病病程15年后，与对照组相比，肾病性糖尿病患者的血压和血糖浓度这两个风险因素均升高（p<0.01）。在肾功能下降阶段，与肾功能进展缓慢的糖尿病患者相比，肾功能不全进展迅速的IDDM患者平均血压更高。虽然这两个风险因素都与糖尿病肾病有关，但在肾功能不全阶段，高血压似乎与肾功能的进一步恶化关系更为密切。
