Bruce R, Williams L, Cundy T
Department of Medicine, Auckland Hospital, New Zealand.
Aust N Z J Med. 1994 Aug;24(4):390-5. doi: 10.1111/j.1445-5994.1994.tb01467.x.
Diabetic nephropathy is now the commonest single cause of end-stage renal failure (ESRF) in New Zealand.
To investigate differences in the natural history of established nephropathy in Type 1 and 2 diabetes.
Retrospective analysis of the rate of progression to ESRF in 17 subjects with Type 1 diabetes (predominantly European) compared to 29 subjects with Type 2 diabetes (all Polynesian). The rate of decline of renal function was determined from serial creatinine measurements (median 5, range 3-8) during progression of chronic renal failure to end stage. Glomerular filtration rate (GFR) was estimated from creatinine measurements using the Cockcroft Gault equation, and the regression slope of these measurements against time was used to determine rate of change of renal function.
GFR fell significantly more rapidly in the group with Type 2 diabetes than in those with Type 1 diabetes: median 1.7 (interquartile range 1.2 to 2.3) mL min-1 month-1 vs 1.1 (interquartile range 0.4 to 1.5) mL min-1 month-1, p = 0.017. During the study period the mean reduction in diastolic blood pressure in subjects with Type 1 diabetes (15 mmHg) was greater than that in the Type 2 subjects (8 mmHg), but the stage at which antihypertensives were commenced was similar in the two groups. Glycaemic control was worse in the subjects with Type 1 diabetes (p < 0.005). The differences in blood pressure control were not significant on analysis of covariance which indicated that ethnicity was the major determinant of the different rates of decline of GFR between the groups. We conclude that in subjects with diabetic nephropathy the rate of progression to ESRF is more rapid in Polynesians with Type 2 diabetes than in Europeans with Type 1 diabetes. This could contribute to the apparent excess of Type 2 diabetic subjects of Polynesian origin on renal replacement programmes in New Zealand.
糖尿病肾病目前是新西兰终末期肾衰竭（ESRF）最常见的单一病因。
研究1型和2型糖尿病已确诊肾病自然病史的差异。
对17例1型糖尿病患者（主要为欧洲人）与29例2型糖尿病患者（均为波利尼西亚人）进展至终末期肾衰竭的速率进行回顾性分析。在慢性肾衰竭进展至终末期期间，通过连续测定肌酐（中位数为5，范围3 - 8）来确定肾功能下降速率。使用Cockcroft Gault方程根据肌酐测量值估算肾小球滤过率（GFR），并将这些测量值随时间的回归斜率用于确定肾功能变化速率。
2型糖尿病组的GFR下降速度明显快于1型糖尿病组：中位数为1.7（四分位间距1.2至2.3）毫升·分钟⁻¹·月⁻¹，而1型糖尿病组为1.1（四分位间距0.4至1.5）毫升·分钟⁻¹·月⁻¹，p = 0.017。在研究期间，1型糖尿病患者舒张压的平均降低幅度（15 mmHg）大于2型糖尿病患者（8 mmHg），但两组开始使用抗高血压药物的阶段相似。1型糖尿病患者的血糖控制较差（p < 0.005）。协方差分析显示血压控制差异不显著，这表明种族是两组间GFR下降速率不同的主要决定因素。我们得出结论，在糖尿病肾病患者中，2型糖尿病的波利尼西亚人进展至终末期肾衰竭的速率比1型糖尿病的欧洲人更快。这可能是新西兰波利尼西亚裔2型糖尿病患者在肾脏替代治疗项目中明显过多的原因。
