Parving H H, Hommel E, Mathiesen E, Skøtt P, Edsberg B, Bahnsen M, Lauritzen M, Hougaard P, Lauritzen E
Hvidöre Hospital, Klampenborg, Denmark.
Br Med J (Clin Res Ed). 1988 Jan 16;296(6616):156-60. doi: 10.1136/bmj.296.6616.156.
Diabetic nephropathy is the main cause of the increased morbidity and mortality in patients with insulin dependent diabetes. The prevalence of microalbuminuria was determined in adults with insulin dependent diabetes of five or more years' duration that had started before the age of 41. All eligible patients (n = 982) attending a diabetes clinic were asked to collect a 24 hour urine sample for analysis of albumin excretion by radioimmunoassay; 957 patients complied. Normoalbuminuria was defined as urinary albumin excretion of less than or equal to 30 mg/24 h (n = 562), microalbuminuria as 31-299 mg/24 h (n = 215), and macroalbuminuria as greater than or equal to 300 mg/24 h (n = 180). The prevalence of microalbuminuria and macroalbuminuria was significantly higher in patients whose diabetes had developed before rather than after the age of 20. The prevalence of arterial hypertension increased with increased albuminuria, being 19%, 30%, and 65% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. The prevalence of proliferative retinopathy and blindness rose with increasing albuminuria, being 12% and 1.4%, respectively, in patients with normoalbuminuria, 28% and 5.6% in those with microalbuminuria and 58% and 10.6% in those with macroalbuminuria. An abnormal vibratory perception threshold was more common in patients with microalbuminuria (31%) and macroalbuminuria (50%) than in those with normoalbuminuria (21%). This study found a high prevalence (22%) of microalbuminuria, which is predictive of the later development of diabetic nephropathy. Microalbuminuria is also characterised by an increased prevalence of arterial hypertension, proliferative retinopathy, blindness, and peripheral neuropathy. Thus, urinary excretion of albumin should be monitored routinely in patients with insulin dependent diabetes.
糖尿病肾病是胰岛素依赖型糖尿病患者发病率和死亡率增加的主要原因。对41岁之前发病且病程达五年或更长时间的胰岛素依赖型成年糖尿病患者进行微量白蛋白尿患病率的测定。要求所有到糖尿病门诊就诊的符合条件的患者（n = 982）收集24小时尿液样本，采用放射免疫分析法分析白蛋白排泄情况；957名患者完成了样本收集。正常白蛋白尿定义为尿白蛋白排泄量小于或等于30 mg/24小时（n = 562），微量白蛋白尿为31 - 299 mg/24小时（n = 215），大量白蛋白尿为大于或等于300 mg/24小时（n = 180）。糖尿病在20岁之前而非之后发病的患者中，微量白蛋白尿和大量白蛋白尿的患病率显著更高。动脉高血压的患病率随白蛋白尿增加而升高，正常白蛋白尿、微量白蛋白尿和大量白蛋白尿患者的患病率分别为19%、30%和65%。增殖性视网膜病变和失明的患病率随白蛋白尿增加而上升，正常白蛋白尿患者中分别为12%和1.4%，微量白蛋白尿患者中为28%和5.6%，大量白蛋白尿患者中为58%和10.6%。异常振动觉阈值在微量白蛋白尿（31%）和大量白蛋白尿（50%）患者中比在正常白蛋白尿患者（21%）中更常见。本研究发现微量白蛋白尿的患病率较高（22%），这可预测糖尿病肾病的后期发展。微量白蛋白尿还具有动脉高血压、增殖性视网膜病变、失明和周围神经病变患病率增加的特征。因此，应常规监测胰岛素依赖型糖尿病患者的尿白蛋白排泄情况。
