Pontuch P, Tŏserová E, Vozár J, Bulas J, Kratochvílová H
First Department of Internal Medicine, Teaching Hospital, Comenius University, Bratislava, Slovakia.
J Diabetes Complications. 1995 Oct-Dec;9(4):234-6. doi: 10.1016/1056-8727(95)80010-c.
We studied 24-h ambulatory blood pressure (SBP, DBP), actual glycemic control assessed from seven blood glucose measurements, 16-h daytime and 8-h nighttime urinary excretion of albumin (UAE) and retinol-binding protein (URBP) in 20 normoalbuminuric (group A, nighttime UAE < 20 micrograms/min) and 20 microalbuminuric and low-proteinuric type I diabetic patients (group B, nighttime UAE 20-500 micrograms/min) matched for age and diabetes duration. Glycemic control was similar in the two groups. Daytime and nighttime SBP and DBP were higher in group B compared to group A (p < 0.01). Nighttime decrease in SBP and DBP correlated with nighttime decrease in UAE in group B (p < 0.05, p < 0.001), but not in group A. There was no correlation between BP and actual glycemic control in either group. We found higher daytime and nighttime URBP in group B compared to group A (p < 0.05). We conclude that, in microalbuminuric and low-proteinuric patients, daytime and nighttime BP was elevated but still in the normal or borderline range, and nighttime decrease in BP correlated with nighttime decrease in UAE but not with actual glycemic control. Increased URBP in these patients suggests slightly impaired proximal tubular function in early stages of diabetic nephropathy.
我们研究了20例正常白蛋白尿患者（A组，夜间尿白蛋白排泄率<20微克/分钟）和20例微量白蛋白尿及低蛋白尿的I型糖尿病患者（B组，夜间尿白蛋白排泄率20 - 500微克/分钟），两组患者年龄和糖尿病病程相匹配，检测了他们的24小时动态血压（收缩压、舒张压）、通过七次血糖测量评估的实际血糖控制情况、16小时白天和8小时夜间尿白蛋白（UAE）及视黄醇结合蛋白（URBP）排泄量。两组的血糖控制情况相似。与A组相比，B组白天和夜间的收缩压及舒张压更高（p<0.01）。B组夜间收缩压和舒张压的下降与夜间UAE的下降相关（p<0.05，p<0.001），而A组则无此相关性。两组中血压与实际血糖控制均无相关性。我们发现，与A组相比，B组白天和夜间的URBP更高（p<0.05）。我们得出结论，在微量白蛋白尿及低蛋白尿患者中，白天和夜间血压升高，但仍处于正常或临界范围内，夜间血压下降与夜间UAE下降相关，但与实际血糖控制无关。这些患者URBP升高提示糖尿病肾病早期近端肾小管功能略有受损。
