Simmons D, Shaw L M, Scott D J, Kenealy T, Scragg R K
Department of Medicine, Auckland University, New Zealand.
Diabetes Care. 1994 Dec;17(12):1404-10. doi: 10.2337/diacare.17.12.1404.
To compare the clinical, anthropometric, and metabolic characteristics of New Zealand Europeans, Maori, and Pacific Islanders with non-insulin-dependent diabetes mellitus (NIDDM) with emphasis on risk factors for the development of diabetic nephropathy.
A cross-sectional survey of 555 (74% of 750 available) diabetic patients attending diabetes clinics and randomly selected primary care centers was conducted in Auckland, New Zealand.
Among those with NIDDM, Maori and Pacific Islanders were younger at diagnosis, more obese, and had poorer glucose control when compared with the Europeans (fructosamine in mumol/l: Maori 335 +/- 78, Pacific Islanders 367 +/- 90, Europeans 318 +/- 55; overall P < 0.001). Systolic blood pressure (sBP) was higher in Maori (145 +/- 31 mmHg) and lower in Pacific Islanders (135 +/- 25 mmHg) when compared with Europeans (141 +/- 25 mmHg; overall P < 0.005). Mean estimated daily urinary albumin excretion (UAE) was 18.2 (15.5-1.3) mg/day in Europeans, 94.8 (60.5-148.7) mg/day in Maori, and 44.2 (32.3-60.3) mg/day in Pacific Islanders. The prevalence of proteinuria and end-stage renal failure were also higher in Maori and Pacific Islanders. The excess prevalence of microalbuminuria and proteinuria in Maori was present within 5 years of diagnosis. Europeans with impaired renal function were least likely to have associated proteinuria or microalbuminuria. Microalbuminuria and nephropathy were not consistently associated with either higher blood pressure or worse glucose control.
NIDDM in Maori and Pacific Islanders is associated with a greater degree of proteinuria and end-stage renal failure than that in Europeans. This observation is not explained by conventional risk factors.
比较新西兰欧洲人、毛利人和太平洋岛民非胰岛素依赖型糖尿病（NIDDM）患者的临床、人体测量和代谢特征，重点关注糖尿病肾病发生的危险因素。
在新西兰奥克兰对555名（占750名可纳入者的74%）就诊于糖尿病诊所及随机选取的初级保健中心的糖尿病患者进行了横断面调查。
在NIDDM患者中，与欧洲人相比，毛利人和太平洋岛民诊断时年龄更小、更肥胖，血糖控制更差（糖化血清蛋白，单位为μmol/L：毛利人335±78，太平洋岛民367±90，欧洲人318±55；总体P<0.001）。与欧洲人（141±25 mmHg）相比，毛利人的收缩压（sBP）更高（145±31 mmHg），太平洋岛民的收缩压更低（135±25 mmHg；总体P<0.005）。欧洲人的平均每日尿白蛋白排泄量（UAE）估计为18.2（15.5 - 1.3）mg/天，毛利人为94.8（60.5 - 148.7）mg/天，太平洋岛民为44.2（32.3 - 60.3）mg/天。毛利人和太平洋岛民蛋白尿和终末期肾衰竭的患病率也更高。毛利人微量白蛋白尿和蛋白尿的额外患病率在诊断后5年内就已出现。肾功能受损的欧洲人发生蛋白尿或微量白蛋白尿的可能性最小。微量白蛋白尿和肾病与更高的血压或更差的血糖控制并无始终一致的关联。
与欧洲人相比，毛利人和太平洋岛民的NIDDM与更严重程度的蛋白尿和终末期肾衰竭相关。这一观察结果无法用传统危险因素来解释。
