Pedrinelli R, Di Bello V, Catapano G, Talarico L, Materazzi F, Santoro G, Giusti C, Mosca F, Melillo E, Ferrari M
I Clinica Medica, University of Pisa, Italy.
Arterioscler Thromb. 1993 Jun;13(6):900-6. doi: 10.1161/01.atv.13.6.900.
Microalbuminuria predicts cardiovascular events in diabetic and nondiabetic patients. For a better understanding of the physiopathological importance of microalbuminuria in atherosclerotic disease, we evaluated the relation between urinary albumin excretion and arterial blood pressure, left ventricular mass, insulin, and lipid levels. The studies were conducted in patients with atherosclerotic peripheral vascular disease. Urinary albumin excretion (studied by nephelometry; an average of triplicate collections from 8 PM to 8 AM), causal blood pressure, echocardiographic left ventricular mass index and wall thickness, plasma immunoreactive insulin and C-peptide (both basally and after a 75-g oral glucose load), blood lipids, and fibrinogen were studied in eight normal subjects and 20 nonobese, nondiabetic male patients with angiographically documented atherosclerotic peripheral vascular disease and preserved renal function, 12 of whom were either hypertensive or on antihypertensive treatment. Eight patients were microalbuminuric (urinary albumin > 20 micrograms/min) and 12 were not. Ankle-arm index and calf and foot transcutaneous oxygen tension were reduced in comparison with normal control subjects but superimposable between the two patient groups to indicate a comparable clinical progression of the vascular disease. In the microalbuminuric subjects, left ventricular mass index was greater, interventricular septum was thicker, and cardiac hypertrophy was more frequent than in nonmicroalbuminuric patients. The prevalence of hypertension tended to be greater and systolic blood pressure values were higher in the presence of microalbuminuria. Overall, a highly significant relation existed between urinary albumin excretion and left ventricular mass. Systolic blood pressure was greater and a history of arterial hypertension was more frequent among microalbuminurics, whereas diastolic blood pressure values showed a statistically significant correlation with both variables.(ABSTRACT TRUNCATED AT 250 WORDS)
微量白蛋白尿可预测糖尿病和非糖尿病患者的心血管事件。为了更好地理解微量白蛋白尿在动脉粥样硬化疾病中的生理病理重要性，我们评估了尿白蛋白排泄与动脉血压、左心室质量、胰岛素及血脂水平之间的关系。研究在患有动脉粥样硬化性外周血管疾病的患者中进行。对8名正常受试者以及20名非肥胖、非糖尿病男性患者进行了研究，这些患者经血管造影证实患有动脉粥样硬化性外周血管疾病且肾功能正常，其中12人患有高血压或正在接受抗高血压治疗。研究了尿白蛋白排泄（通过散射比浊法测定；晚上8点至次日早上8点平均收集三份样本）、偶测血压、超声心动图测定的左心室质量指数和室壁厚度、血浆免疫反应性胰岛素和C肽（基础状态及口服75克葡萄糖负荷后）、血脂以及纤维蛋白原。20名患者中8人存在微量白蛋白尿（尿白蛋白>20微克/分钟），12人无微量白蛋白尿。与正常对照受试者相比，踝臂指数以及小腿和足部经皮氧分压降低，但两组患者之间可叠加，表明血管疾病的临床进展相当。与无微量白蛋白尿的患者相比，微量白蛋白尿患者的左心室质量指数更大，室间隔更厚，心脏肥大更常见。微量白蛋白尿患者中高血压患病率往往更高，收缩压值也更高。总体而言，尿白蛋白排泄与左心室质量之间存在高度显著的关系。微量白蛋白尿患者的收缩压更高，动脉高血压病史更常见，而舒张压值与这两个变量均存在统计学显著相关性。（摘要截短于250字）
