Hoogenberg K, Girbes A R, Stegeman C A, Sluiter W J, Reitsma W D, Dullaart R P
Division of Endocrinology, Groningen State University Hospital, The Netherlands.
Scand J Clin Lab Invest. 1995 Feb;55(1):15-22. doi: 10.3109/00365519509075374.
Imbalances in renal vasodilatory and vasoconstrictive mechanisms are responsible for the renal haemodynamic changes observed in Type 1 diabetes mellitus. Animal experiments have shown that noradrenaline (NA) infusion increases the intraglomerular pressure by predominantly efferent arteriolar vasoconstriction. The relationships between ambient plasma NA levels and renal haemodynamics were studied in 18 healthy control subjects (group C); in 17 normoalbuminuric diabetic patients (group D1) (albumin excretion rate (Ualb V) < 20 micrograms min-1), and in 17 microalbuminuric Type 1 diabetic patients (group D2) (UalbV 20-200 micrograms min-1), all patients being without overt autonomic neuropathy. Supine glomerular filtration rate (GFR (ml min-1 1.73 m-2)) and effective renal plasma flow (ERPF (ml min-1 1.73 m-2)) were determined over a 2-h period using constant infusions of 125I-iothalamate and 131I-hippuran, respectively. The subjects were studied in the fasting state. The diabetic patients were investigated during near normoglycaemia. Data are given as means and SD. In group D1, GFR and ERPF (126 +/- 15 and 538 +/- 89, respectively) were elevated as compared with controls (108 +/- 15 and 478 +/- 73; p < 0.01 and p < 0.05, respectively). In group D2, GFR (124 +/- 25, p < 0.05) but not ERPF (515 +/- 104) was higher than in the controls. GFR and ERPF were negatively correlated with venous plasma NA in group C (r = -0.61, p < 0.005 and r = -0.64, p < 0.001, respectively), in group D1 (r = -0.54, p < 0.03 and r = -0.63, p < 0.005, respectively) and in group D2 (r = 0.53, p < 0.03 and r = -0.60, p < 0.01, respectively). Multiple regression analysis disclosed that diabetes per se, independent from plasma NA, had a positive contribution to GFR. In contrast, ERPF was only related to plasma NA levels. GFR and ERPF are inversely related to venous plasma NA levels, both in healthy and in diabetic subjects, supporting the hypothesis that plasma NA is a vasoconstrictive substance. The independent positive effect of diabetes as a categorial variable on GFR, suggests that concomitant vasodilating mechanisms play a role in the renal haemodynamic alterations in Type 1 diabetes mellitus.
肾血管舒张和收缩机制的失衡是1型糖尿病中所观察到的肾血流动力学变化的原因。动物实验表明，输注去甲肾上腺素（NA）主要通过出球小动脉收缩来升高肾小球内压力。在18名健康对照受试者（C组）、17名正常白蛋白尿糖尿病患者（D1组）（白蛋白排泄率（Ualb V）<20微克/分钟）和17名微量白蛋白尿1型糖尿病患者（D2组）（UalbV 20 - 200微克/分钟）中研究了外周血浆NA水平与肾血流动力学之间的关系，所有患者均无明显自主神经病变。使用125I - 碘肽酸盐和131I - 马尿酸的持续输注分别在2小时内测定仰卧位肾小球滤过率（GFR（毫升/分钟·1.73平方米））和有效肾血浆流量（ERPF（毫升/分钟·1.73平方米））。受试者在禁食状态下进行研究。糖尿病患者在接近正常血糖状态下进行检查。数据以均值和标准差表示。在D1组中，GFR和ERPF（分别为126±15和538±89）与对照组（108±15和478±73；p分别<0.01和p<0.05）相比升高。在D2组中，GFR（124±25，p<0.05）但ERPF（515±104）高于对照组。在C组（r = -0.61，p<0.005和r = -0.64，p<0.001，分别）、D1组（r = -0.54，p<0.03和r = -0.63，p<0.005，分别）和D2组（r = 0.53，p<0.03和r = -0.60，p<0.01，分别）中，GFR和ERPF与静脉血浆NA呈负相关。多元回归分析显示，独立于血浆NA的糖尿病本身对GFR有正向作用。相反，ERPF仅与血浆NA水平相关。在健康受试者和糖尿病患者中，GFR和ERPF均与静脉血浆NA水平呈负相关，支持血浆NA是一种血管收缩物质的假设。糖尿病作为一个分类变量对GFR的独立正向作用表明，伴随的血管舒张机制在1型糖尿病的肾血流动力学改变中起作用。
