Almdal T, Nörgaard K, Feldt-Rasmussen B, Deckert T
Steno Diabetes Center, Gentofte, Denmark.
Diabetes Care. 1994 Feb;17(2):120-5. doi: 10.2337/diacare.17.2.120.
To investigate the predictive value of microalbuminuria and the annual increase of albumin excretion as risk factors for diabetic nephropathy.
A 5-year follow-up of patients with microalbuminuria (urinary albumin excretion [UAE] = 30-299 mg/24 h) and matched patients with normoalbuminuria (UAE < 30 mg/24 h). The initial classification was based on one single 24-h urine collection. The annual increase in UAE was calculated by linear regression analysis of log-transformed UAE on time. This study was conducted at the outpatient clinic of the Steno Diabetes Center. The study subjects included 118 insulin-dependent diabetes mellitus (IDDM) patients between 18 and 50 years of age with microalbuminuria and 112 matched control patients with normal UAE with an age at diabetes onset of < 31 years. The main outcome measures were UAE, annual change in UAE rate (percentage per year), and the prevalence of retinopathy.
After 5 years, 39 (33%, 24-42 CI [95% confidence interval]) patients with microalbuminuria had normoalbuminuria, 57 (48%, 38-57 CI) still had microalbuminuria, and 22 (19%, 12-27 CI) had developed diabetic nephropathy. Among the 112 patients with normoalbuminuria in 1985, 9 (8%, 4-15 CI) had developed microalbuminuria, and 2 (2%, 0-6 CI) had developed diabetic nephropathy. Of the 79 patients with persistent albuminuria, only 36 (46%, 34-57 CI) were progressors with a rate of progression of > 5%/year. Progressors had significantly higher HbAlc, higher mean blood pressure, and a higher incidence of proliferative retinopathy compared with nonprogressors. Multiple regression analysis only identified mean HbAlc as an independent predictor of the rate of progression. Smoking was significantly more prevalent in patients with persistent albuminuria.
Microalbuminuria is a predictor of progression to diabetic nephropathy; however, not as strong as suggested previously. Calculation of the annual increase in UAE seems to be a more specific method of identifying patients who will develop diabetic nephropathy.
研究微量白蛋白尿及白蛋白排泄量的年增长情况作为糖尿病肾病危险因素的预测价值。
对微量白蛋白尿患者（尿白蛋白排泄率[UAE]=30 - 299mg/24小时）和匹配的正常白蛋白尿患者（UAE<30mg/24小时）进行为期5年的随访。初始分类基于单次24小时尿液收集。通过对经对数转换的UAE与时间进行线性回归分析来计算UAE的年增长情况。本研究在斯滕诺糖尿病中心门诊进行。研究对象包括118例年龄在18至50岁之间的胰岛素依赖型糖尿病（IDDM）微量白蛋白尿患者以及112例匹配的UAE正常的对照患者，糖尿病发病年龄<31岁。主要观察指标为UAE、UAE率的年变化（每年的百分比）以及视网膜病变的患病率。
5年后，39例（33%，24 - 42可信区间[95%置信区间]）微量白蛋白尿患者转为正常白蛋白尿，57例（48%，38 - 57可信区间）仍有微量白蛋白尿，22例（19%，12 - 27可信区间）发展为糖尿病肾病。在1985年的112例正常白蛋白尿患者中，9例（8%，4 - 15可信区间）发展为微量白蛋白尿，2例（2%，0 - 6可信区间）发展为糖尿病肾病。在79例持续性白蛋白尿患者中，只有36例（46%，34 -
