Wiseman M J, Saunders A J, Keen H, Viberti G
N Engl J Med. 1985 Mar 7;312(10):617-21. doi: 10.1056/NEJM198503073121004.
To investigate the relation between blood glucose control on the one hand and an increased glomerular filtration rate and enlarged kidneys on the other, we studied 12 patients with insulin-dependent diabetes and an increased glomerular filtration rate for a year after they were randomly assigned either to continuous subcutaneous insulin infusion or to unchanged conventional therapy. Glycemic control, measured by mean plasma concentrations of glucose and glycosylated hemoglobin, was rapidly and significantly improved (P less than 0.001) in the pump group but did not change in the conventional-treatment group. In the pump group, the glomerular filtration rate fell significantly in the study period (P less than 0.001) and became normal in four of the six patients. It did not change in the conventional-treatment group. There was no change in kidney volume in either group. At the end of a year, a return to conventional insulin treatment in the pump group resulted in both metabolic deterioration and a significant rise in the mean glomerular filtration rate toward base-line values. We conclude that in patients with established insulin-dependent diabetes, strict glycemic control normalizes the glomerular filtration rate, although the kidneys may remain enlarged.
为了研究血糖控制与肾小球滤过率增加及肾脏增大之间的关系，我们对12例胰岛素依赖型糖尿病且肾小球滤过率增加的患者进行了研究，这些患者被随机分为持续皮下胰岛素输注组或维持不变的传统治疗组，观察一年。通过平均血浆葡萄糖浓度和糖化血红蛋白来衡量的血糖控制，在胰岛素泵治疗组迅速且显著改善（P<0.001），而在传统治疗组则无变化。在胰岛素泵治疗组，研究期间肾小球滤过率显著下降（P<0.001），6例患者中有4例恢复正常。在传统治疗组肾小球滤过率没有变化。两组的肾脏体积均无变化。一年结束时，胰岛素泵治疗组恢复传统胰岛素治疗导致代谢恶化，且平均肾小球滤过率显著回升至基线值。我们得出结论，在已确诊的胰岛素依赖型糖尿病患者中，严格的血糖控制可使肾小球滤过率恢复正常，尽管肾脏可能仍会增大。
