Hasslacher C, Stech W, Wahl P, Ritz E
Diabetologia. 1985 Jan;28(1):6-11. doi: 10.1007/BF00276992.
The respective rôles of arterial blood pressure and metabolic control in different stages of diabetic nephropathy were analyzed retrospectively in 52 sequentially-followed Type 1 (insulin-dependent) diabetic patients. A negative correlation was found between median post-prandial blood glucose and median duration of diabetes until onset of persistent proteinuria (p less than 0.01). Systolic blood pressure was higher in patients who subsequently developed persistent proteinuria than those who did not (140 versus 121 mmHg; p less than 0.05), but duration of the interval until onset of persistent proteinuria was not related to blood pressure. After onset of persistent proteinuria, hypertensive diabetic patients developed elevated serum creatinine concentrations more frequently than normotensive diabetic patients (67% versus 14%, p less than 0.05). In these patients, the delay until elevation of serum creatinine concentration was negatively correlated with blood glucose (p less than 0.01). Once serum creatinine was raised, decay of renal function occurred faster in patients with persistent than intermittent hypertension (p less than 0.05). No effect of metabolic control was demonstrable at this stage of nephropathy. It is concluded that metabolic control determines the early course of diabetic nephropathy, whereas blood pressure is more important in advanced stages of nephropathy.
对52例接受连续随访的1型（胰岛素依赖型）糖尿病患者进行回顾性分析，以探讨动脉血压和代谢控制在糖尿病肾病不同阶段所起的各自作用。发现餐后血糖中位数与糖尿病持续时间直至持续性蛋白尿出现之间呈负相关（p<0.01）。随后发生持续性蛋白尿的患者收缩压高于未发生者（140对121 mmHg；p<0.05），但直至持续性蛋白尿出现的间隔时间与血压无关。持续性蛋白尿出现后，高血压糖尿病患者血清肌酐浓度升高的频率高于血压正常的糖尿病患者（67%对14%，p<0.05）。在这些患者中，血清肌酐浓度升高的延迟时间与血糖呈负相关（p<0.01）。一旦血清肌酐升高，持续性高血压患者肾功能衰退的速度比间歇性高血压患者更快（p<0.05）。在肾病的这个阶段，未显示出代谢控制有任何作用。得出的结论是，代谢控制决定糖尿病肾病的早期病程，而血压在肾病晚期更为重要。
