Molitch M E, Steffes M W, Cleary P A, Nathan D M
DCCT Research Group, Bethesda, Maryland 20892.
Kidney Int. 1993 Mar;43(3):668-74. doi: 10.1038/ki.1993.96.
To determine whether there are relationships between nephropathy, retinopathy and putative risk factors at points very early in the development of long-term complications of IDDM, we have analyzed baseline data pertinent to nephropathy in the 726 subjects in the primary prevention cohort and the 715 subjects in the secondary intervention cohort of the DCCT. AER correlated positively with CCr and HbA1c in both cohorts and with degree of retinopathy and duration of IDDM in the secondary cohort. Within the secondary cohort only mean BP and HbA1c levels were significantly increased (P < 0.005) in the 73 subjects with AER > or = 28 micrograms/24 hr compared to the 642 subjects with AER < 28 micrograms/24 hr. Stratification of all subjects in the secondary cohort showed significant associations (P < 0.001) between retinopathy level, AER, duration of diabetes at entry and entry HbA1c. Even very early in the development of retinopathy and nephropathy, there is a relationship between them and with level of metabolic control. The prospective studies of the DCCT are designed to answer the question of whether intensive diabetes treatment will affect the development and/or progression of retinopathy, and, possibly, of nephropathy.
为了确定在胰岛素依赖型糖尿病（IDDM）长期并发症发展的极早期，肾病、视网膜病变与假定危险因素之间是否存在关联，我们分析了糖尿病控制与并发症试验（DCCT）一级预防队列中的726名受试者以及二级干预队列中的715名受试者与肾病相关的基线数据。在两个队列中，尿白蛋白排泄率（AER）均与肌酐清除率（CCr）和糖化血红蛋白（HbA1c）呈正相关，在二级队列中还与视网膜病变程度和IDDM病程呈正相关。在二级队列中，与AER＜28微克/24小时的642名受试者相比，AER≥28微克/24小时的73名受试者仅平均血压和HbA1c水平显著升高（P＜0.005）。对二级队列中的所有受试者进行分层分析显示，视网膜病变程度、AER、入组时糖尿病病程和入组时HbA1c之间存在显著关联（P＜0.001）。即使在视网膜病变和肾病发展的极早期，它们之间以及与代谢控制水平之间也存在关联。DCCT的前瞻性研究旨在回答强化糖尿病治疗是否会影响视网膜病变以及可能的肾病的发生和/或进展这一问题。
