Watts G F, Powrie J K, O'Brien S F, Shaw K M
Department of Medicine, University of Western Australia, Royal Perth Hospital, Australia.
Metabolism. 1996 Sep;45(9):1101-7. doi: 10.1016/s0026-0495(96)90009-8.
The purpose of the study was to examine the contribution of alterations in lipoprotein metabolism to the progression of very-low-level albuminuria in insulin-dependent diabetes mellitus (IDDM). We measured serum concentrations of lipids, lipoproteins, and apolipoproteins in 53 normoalbuminuric diabetic patients without overt hypertension, whom we restudied after 10 years. Albuminuria was measured as the urinary albumin to creatinine ratio (UA/UC) in repeated early-morning samples. Over 10 years, UA/UC increased significantly (P < .001), and five patients (9.4%) progressed to microalbuminuria. The increase in albuminuria was significantly and positively related to the baseline serum concentrations of total cholesterol (P < .05), low-density lipoprotein (LDL) cholesterol (P = .05), non-high-density lipoprotein (HDL) cholesterol (P < .05), and apolipoprotein (apo) B (P < .001), but no significant associations were found with triglycerides, HDL cholesterol, apo A-1, or lipoprotein(a) [Lp(a)]. The relative risk of developing microalbuminuria for a serum apo B concentration more than 1.1 g/L was 3.8 (95% confidence interval [CI], 1.9 to 7.7). In multiple linear regression analysis, serum apo B (P < .05) and glycated hemoglobin ([HbA] P < .05) at baseline were significant independent predictors of the increase in albuminuria, with no significant associations found for sex, smoking, duration of diabetes, mean arterial blood pressure (BP), or family history of cardiovascular disease and hypertension; the regression model predicted 42% of the variation in UA/UC at 10 years. The findings suggest that an abnormality in the metabolism of apo B may be independently associated with progression of very-low-level albuminuria and possibly with the development of early nephropathy in IDDM patients.
本研究的目的是探讨脂蛋白代谢改变对胰岛素依赖型糖尿病（IDDM）患者极低水平蛋白尿进展的影响。我们测定了53例无明显高血压的正常白蛋白尿糖尿病患者的血脂、脂蛋白和载脂蛋白血清浓度，并在10年后对他们进行了再次研究。通过重复测定清晨样本中的尿白蛋白与肌酐比值（UA/UC）来检测蛋白尿。在10年期间，UA/UC显著升高（P <.001），5例患者（9.4%）进展为微量白蛋白尿。蛋白尿的增加与基线血清总胆固醇浓度（P <.05）、低密度脂蛋白（LDL）胆固醇（P =.05）、非高密度脂蛋白（HDL）胆固醇（P <.05）和载脂蛋白（apo）B（P <.001）显著正相关，但与甘油三酯、HDL胆固醇、apo A-1或脂蛋白（a）[Lp（a）]无显著相关性。血清apo B浓度超过1.1 g/L时发生微量白蛋白尿的相对风险为3.8（95%置信区间[CI]，1.9至7.7）。在多元线性回归分析中，基线时血清apo B（P <.05）和糖化血红蛋白（[HbA] P <.05）是蛋白尿增加的显著独立预测因素，而性别、吸烟、糖尿病病程、平均动脉血压（BP）或心血管疾病和高血压家族史无显著相关性；回归模型预测了10年时UA/UC变化的42%。这些发现表明，apo B代谢异常可能与IDDM患者极低水平蛋白尿的进展独立相关，并可能与早期肾病的发生有关。
