Okada S, Ichiki K, Hamada H, Matsuo N, Ota Z
Third Department of Medicine, Okayama University Medical School, Japan.
J Int Med Res. 1996 Jan-Feb;24(1):47-58. doi: 10.1177/030006059602400107.
This study examined factors contributing to the development of microalbuminuria in diabetic patients. A total of 236 patients with Type 2 diabetes were studied: 143 were normoalbuminuric and 86 were also normotensive. Multiple regression analysis was used to identify factors influencing the urinary albumin index (UAI), an index of proteinuria based on urinary albumin adjusted for urinary creatinine. Significant factors (retinopathy, systolic blood pressure, and glycosylated haemoglobin) were used to generate a formula for estimating the log(e) UAI. Target values for systolic blood pressure and glycosylated haemoglobin to maintain the urinary albumin index at or below 22 were determined for different degrees of retinopathy. Normoalbuminuric patients were followed for 3 years to evaluate their progression to microalbuminuria. Each month, blood pressure, urinary albumin and creatinine, and glycosylated haemoglobin were measured. In normotensive, normoalbuminuric patients, initial urinary albumin index and log(e) UAI were significantly higher in patients who subsequently developed microalbuminuria. Patients with initial log(e) UAI > 3.09 or initial glycosylated haemoglobin > 6.0% also showed greater progression to microalbuminuria. Hyperglycaemia was an independent factor for the development of microalbuminuria in Type 2 diabetes. The urinary albumin index was most significantly affected by retinopathy, systolic blood pressure, and glycosylated haemoglobin. The estimated loge UAI calculated from these factors is a useful predictor of progression to microalbuminuria.
本研究探讨了糖尿病患者微量白蛋白尿发生发展的相关因素。共对236例2型糖尿病患者进行了研究：其中143例为正常白蛋白尿患者，且86例血压也正常。采用多元回归分析来确定影响尿白蛋白指数（UAI）的因素，UAI是一种基于尿白蛋白并经尿肌酐校正的蛋白尿指标。利用显著因素（视网膜病变、收缩压和糖化血红蛋白）生成了一个估算log(e)UAI的公式。针对不同程度的视网膜病变，确定了将尿白蛋白指数维持在22或以下的收缩压和糖化血红蛋白目标值。对正常白蛋白尿患者进行了3年随访，以评估其向微量白蛋白尿的进展情况。每月测量血压、尿白蛋白和肌酐以及糖化血红蛋白。在血压正常的正常白蛋白尿患者中，随后发生微量白蛋白尿的患者其初始尿白蛋白指数和log(e)UAI显著更高。初始log(e)UAI>3.09或初始糖化血红蛋白>6.0%的患者向微量白蛋白尿的进展也更大。高血糖是2型糖尿病患者微量白蛋白尿发生的独立因素。尿白蛋白指数受视网膜病变、收缩压和糖化血红蛋白的影响最为显著。根据这些因素计算出的估算loge UAI是微量白蛋白尿进展的有用预测指标。
