Müller W A
Sektion Versicherungsmedizin, Aus der Schweizer Rück, Zürich.
Versicherungsmedizin. 1996 Jun 1;48(3):70-6.
Microalbuminuria (MA) is a term used for urinary albumin excretion between 20 and 200 micrograms/min. or 30-300 mg/24 h. This definition is not used by all authors. In addition, various methods may influence the results. The significance of MA concerns the prognosis in diabetics. For the juvenile type 1 diabetes nephropathy is the most important complication. In adult type 2 diabetics the prognosis concerns mainly cardiovascular death. The excess mortality to be attributed to MA is several fold in type 1 diabetes, less in the adult onset type variety. MA is the expression of an incipient general disease of blood vessels touching as much the kidney as the heart. According to the presence or absence of other vascular damage. MA develops toward nephropathy or cardiovascular complications. The features leading to or worsening MA are elevated blood pressure, poor glucose control, elevated lipoproteins, diminished insulin sensitivity and probably smoking. Retinopathy is an indicator for particularly sensitive patients responding with the development of MA upon only mildly elevated blood pressure or poor metabolic control. The prevalence of MA is close to 20% for both types of diabetes. Non-diabetic persons under 60 years of age exhibit MA in 2-10%, the elderly in 20-30%. For non-diabetic persons with hypertension MA is reported to be present in 19%. Over a time span of 5 years, 19% of type 1 patients with MA develop proteinuria of more than 300 mg/24 hours. In a third of cases albumin excretion normalises. In the remaining half a small progression of MA occurs. For type 2 patients the increased mortality risk is restricted to the first 5 years, thereafter the survival curves return to those of patients without MA. In these patients the excess mortality is already present at albumin excretion rates above 10 micrograms/min. Higher values have, therefore, to be considered pathological. For the treatment of the syndrome ACE-inhibitors and ev. Ca-antagonists (with the exception of dihydropyridine, nifedipine) are recommended. They reduce albumin excretion by 50%. In a single study (yet) with type 1 diabetes mortality also was reduced by 40-50%. This would imply that the excess mortality could be halved in patients undergoing this treatment.
微量白蛋白尿（MA）是指尿白蛋白排泄量在20至200微克/分钟之间或30 - 300毫克/24小时之间。并非所有作者都采用这一定义。此外，各种方法可能会影响结果。MA的意义与糖尿病患者的预后相关。对于青少年1型糖尿病，肾病是最重要的并发症。在成年2型糖尿病患者中，预后主要涉及心血管死亡。1型糖尿病中归因于MA的额外死亡率是几倍，成年发病型则较低。MA是一种初期全身性血管疾病的表现，对肾脏和心脏的影响程度相同。根据是否存在其他血管损伤，MA会发展为肾病或心血管并发症。导致或加重MA的特征包括血压升高、血糖控制不佳、脂蛋白升高、胰岛素敏感性降低以及可能的吸烟。视网膜病变是一个指标，表明某些特别敏感的患者在血压仅轻度升高或代谢控制不佳时就会出现MA。两种类型的糖尿病患者中MA的患病率接近20%。60岁以下的非糖尿病患者中，MA的发生率为2% - 10%，老年人中为20% - 30%。据报道，患有高血压的非糖尿病患者中MA的发生率为19%。在5年的时间跨度内，1型MA患者中有19%会发展为24小时蛋白尿超过300毫克。三分之一的病例中白蛋白排泄恢复正常。在其余的一半病例中，MA会有轻微进展。对于2型患者，增加的死亡风险仅限于最初5年，此后生存曲线恢复到无MA患者的水平。在这些患者中，白蛋白排泄率高于10微克/分钟时就已经存在额外死亡率。因此，更高的值应被视为病理性的。对于该综合征的治疗，推荐使用ACE抑制剂以及（除二氢吡啶类硝苯地平外的）钙拮抗剂。它们可使白蛋白排泄减少50%。在一项针对1型糖尿病的单一研究中（目前），死亡率也降低了40% - 50%。这意味着接受这种治疗的患者额外死亡率可能会减半。
