Myrup B, Mathiesen E R, Rønn B, Deckert T
Steno Diabetes Center, Gentofte, Denmark.
Diabetes Res. 1994;26(1):33-9.
Changed endothelial function and dyslipidemia are features of insulin-dependent diabetes mellitus complicated with clinical nephropathy. The time relationship between the appearance of these abnormalities is however not well known. We have therefore studied the coincidence of microalbuminuria, endothelial dysfunction and dyslipidemia during a 10 year prospective study of 209 insulin-dependent diabetic patients with normal urinary albumin excretion. Twenty-three patients developed progressing microalbuminuria defined as a median urinary albumin excretion > 30 mg/24-h in two consecutive years and a progression rate in albuminuria higher than 5% per year. Thirty patients who remained normoalbuminuric throughout the observation period were randomly selected to obtain a control group with comparable degree of glycaemic control. The mean level of von Willebrand factor before onset of microalbuminuria tended to be higher in patients developing microalbuminuria than in the control group (NS), but there was no increase in von Willebrand factor in the patients who developed microalbuminuria. Total cholesterol did not change, but a significant decrease in high density lipoprotein cholesterol was observed in patients who developed microalbuminuria. In conclusion, the study demonstrated coincidence of microalbuminuria and decreasing high density lipoprotein cholesterol, but no coincidence between onset of microalbuminuria and endothelial dysfunction assessed by von Willebrand factor.
内皮功能改变和血脂异常是胰岛素依赖型糖尿病合并临床肾病的特征。然而，这些异常出现的时间关系尚不清楚。因此，我们在一项对209例尿白蛋白排泄正常的胰岛素依赖型糖尿病患者进行的为期10年的前瞻性研究中，研究了微量白蛋白尿、内皮功能障碍和血脂异常的相关性。23例患者出现进行性微量白蛋白尿，定义为连续两年尿白蛋白排泄中位数>30mg/24小时，且白蛋白尿进展率每年高于5%。随机选择30例在整个观察期内尿白蛋白正常的患者作为血糖控制程度相当的对照组。微量白蛋白尿发作前血管性血友病因子的平均水平在发生微量白蛋白尿的患者中往往高于对照组（无统计学意义），但发生微量白蛋白尿的患者血管性血友病因子没有增加。总胆固醇没有变化，但发生微量白蛋白尿的患者高密度脂蛋白胆固醇显著降低。总之，该研究表明微量白蛋白尿与高密度脂蛋白胆固醇降低同时存在，但微量白蛋白尿的发作与通过血管性血友病因子评估的内皮功能障碍之间没有相关性。
