正常滤过和高滤过正常白蛋白尿的非胰岛素依赖型糖尿病患者肾小球滤过率和白蛋白排泄率的五年前瞻性研究。

Five-year prospective study of glomerular filtration rate and albumin excretion rate in normofiltering and hyperfiltering normoalbuminuric NIDDM patients.

作者信息

Silveiro S P, Friedman R, de Azevedo M J, Canani L H, Gross J L

机构信息

Endocrinology Division, Hospital de Clínicas de Porto Alegre, Brazil.

出版信息

Diabetes Care. 1996 Feb;19(2):171-4. doi: 10.2337/diacare.19.2.171.

DOI:10.2337/diacare.19.2.171

PMID:8718441

Abstract

OBJECTIVE

To evaluate the evolution of glomerular filtration rate (GFR) and albumin excretion rate (AER) of normofiltering (NF) and hyperfiltering (HF) normoalbuminuric NIDDM patients.

RESEARCH DESIGN AND METHODS

A longitudinal study of 32 normoalbuminuric (AER < 20 micrograms/min) NIDDM patients and 20 age-, sex-, and BMI-matched normal individuals was done. Subjects had their GFR (51Cr-labeled EDTA single-injection method) measured at entry and after 40 and 60 months. At entry, 13 NIDDM patients had GFR values above the upper limit of the normal range in our laboratory (> 137 ml.min-1 x 1.73 m-2) and were considered as HF. In NIDDM patients, the 24-h AER (radioimmunoassay), HbA1c, urinary urea, and mean arterial blood pressure (MBP) were analyzed at entry and after 40 and 60 months.

RESULTS

There was a significant decline of GFR in NIDDM patients and normal subjects at 60 months. The decline was significantly greater in HF patients (-0.61 ml.min-1.month-1; P = 0.001) than in NF (-0, 18) and control subjects (-0, 14); the rate of change in NF and control subjects was the same (P > 0.05). In stepwise multiple regression analysis, with GFR decline as the dependent variable and GFR and AER at baseline, age and change in MBP, change in urinary urea, change in HbA1c, and change in therapy as independent variables, only baseline GFR (R2 = 0.19, P = 0.002) and age (R2 = 0.31, P = 0.048) were significantly related to the outcome. At 60 months, AER raised > 20 micrograms/min in three HF and in four NF patients. In logistic regression analysis, only higher initial AER (although still in the normal range; P = 0.037) and an increase in urinary urea (P = 0.021) were significantly related to the later development of microalbuminuria.

CONCLUSIONS

The GFR of normoalbuminuric NIDDM patients declines significantly over 60 months. This decline is associated to baseline GFR and age. HF NIDDM patients show a faster decline in GFR than NF patients, whose GFR falls at a rate that is compatible with the age-related change observed in normal control subjects. The development of microalbuminuria is related to higher baseline AER and to increases in urinary urea and is similar in NF (4 of 19) and HF (3 of 13) NIDDM patients (P > 0.05).

摘要

目的

评估正常滤过（NF）和高滤过（HF）的正常白蛋白尿型2型糖尿病（NIDDM）患者的肾小球滤过率（GFR）和白蛋白排泄率（AER）的变化情况。

研究设计与方法

对32例正常白蛋白尿（AER＜20微克/分钟）的NIDDM患者和20例年龄、性别及体重指数相匹配的正常个体进行了一项纵向研究。受试者在入组时、40个月及60个月后测量其GFR（51Cr标记的乙二胺四乙酸单次注射法）。入组时，13例NIDDM患者的GFR值高于我们实验室正常范围的上限（＞137毫升·分钟-1×1.73平方米-2），被视为HF。在NIDDM患者中，于入组时、40个月及60个月后分析24小时AER（放射免疫测定法）、糖化血红蛋白（HbA1c）、尿尿素及平均动脉血压（MBP）。

结果

在60个月时，NIDDM患者和正常受试者的GFR均显著下降。HF患者的下降幅度（-0.61毫升·分钟-1·月-1；P = 0.001）显著大于NF患者（-0.18）和对照组受试者（-0.14）；NF患者和对照组受试者的变化率相同（P＞0.05）。在逐步多元回归分析中，以GFR下降作为因变量，以基线时的GFR和AER、年龄、MBP变化、尿尿素变化、HbA1c变化及治疗变化作为自变量，只有基线GFR（R2 = 0.19，P = 0.002）和年龄（R2 = 0.31，P = 0.048）与结果显著相关。在60个月时，3例HF患者和4例NF患者的AER升高至＞20微克/分钟。在逻辑回归分析中，只有较高的初始AER（尽管仍在正常范围内；P = 0.037）和尿尿素增加（P = 0.021）与微量白蛋白尿的后期发生显著相关。

结论

正常白蛋白尿型NIDDM患者的GFR在60个月内显著下降。这种下降与基线GFR和年龄有关。HF NIDDM患者的GFR下降速度比NF患者快，NF患者GFR下降的速率与正常对照受试者中观察到的与年龄相关的变化相符。微量白蛋白尿的发生与较高的基线AER以及尿尿素增加有关，在NF（19例中的4例）和HF（13例中的3例）NIDDM患者中相似（P＞0.05）。