Mulec H, Johnsen S A, Wiklund O, Björck S
Department of Nephrology, Sahlgrenska Hospital, University of Göteborg, Sweden.
Am J Kidney Dis. 1993 Jul;22(1):196-201. doi: 10.1016/s0272-6386(12)70186-5.
In a prospective follow-up of 30 patients with type 1 diabetes and nephropathy, serum cholesterol, triglycerides, apolipoprotein Al and B, and lipoprotein(a) were determined to study their relationship to the rate of decline in glomerular filtration rate. The patients had proteinuria and advanced nephropathy with a mean +/- SD glomerular filtration rate of 39 mL/min/1.73 m2. The decline in glomerular filtration rate was determined during 2.5 +/- 0.5 years. High serum cholesterol, triglycerides, and apolipoprotein B were correlated to a more rapid deterioration in kidney function. The rate of decline in glomerular filtration rate was 1.0 +/- 2.5 mL/min/yr in the 10 patients with the lowest cholesterol level, compared with 4.5 +/- 3.2 mL/min/yr in the patients with the highest serum cholesterol (P = 0.015). The combined effect of the measured lipids, blood pressure, type of antihypertensive treatment, protein intake, proteinuria, and hemoglobin A1C on the rate of decline in glomerular filtration rate was assessed by multiple regression analysis. The measured factors together had a high explanatory power for the rate of decline in glomerular filtration rate. In this model, 73% of the variation in decline in glomerular filtration rate was explained by the measured variables (multiple r2 = 0.73). Low cholesterol and treatment with an angiotensin-converting enzyme inhibitor were the strongest predictors of a favorable renal prognosis. This suggests that hypercholesterolemia is an important risk factor for diabetic nephropathy.
在一项对30例1型糖尿病肾病患者的前瞻性随访研究中，测定了血清胆固醇、甘油三酯、载脂蛋白A1和B以及脂蛋白(a)，以研究它们与肾小球滤过率下降速率的关系。这些患者存在蛋白尿和晚期肾病，平均肾小球滤过率为39 mL/min/1.73 m2（均值±标准差）。在2.5±0.5年期间测定了肾小球滤过率的下降情况。高血清胆固醇、甘油三酯和载脂蛋白B与肾功能更快恶化相关。胆固醇水平最低的10例患者肾小球滤过率下降速率为1.0±2.5 mL/min/年，而血清胆固醇水平最高的患者为4.5±3.2 mL/min/年（P = 0.015）。通过多元回归分析评估了所测脂质、血压、降压治疗类型、蛋白质摄入量、蛋白尿和糖化血红蛋白A1C对肾小球滤过率下降速率的综合影响。所测因素共同对肾小球滤过率下降速率具有较高的解释力。在该模型中，73%的肾小球滤过率下降变异可由所测变量解释（多元相关系数r2 = 0.73）。低胆固醇水平和使用血管紧张素转换酶抑制剂治疗是肾脏预后良好的最强预测因素。这表明高胆固醇血症是糖尿病肾病的一个重要危险因素。
