Savage S, Estacio R O, Jeffers B, Schrier R W
Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Diabetes Care. 1996 Nov;19(11):1243-8. doi: 10.2337/diacare.19.11.1243.
The relationship between urinary albumin excretion (UAE) and diabetic complications in NIDDM has not been studied in a large American population. The demonstrated relationship between increased UAE and the development of retinopathy, nephropathy, and neuropathy in IDDM makes this an important issue to also be studied in NIDDM patients.
A large population study of 947 NIDDM patients living predominantly in a metropolitan area was undertaken. Three categories of UAE, namely, normal albuminuria (< 20 micrograms/min), microalbuminuria (20-200 micrograms/min), and overt albuminuria (> 200 micrograms/min) were compared with 1) retinopathy as assessed by stereoscopic fundus photographs; 2) cardiovascular disease as assessed by a history of cardiac disease or stroke; ischemic changes on exercise treadmill testing; Q wave myocardial infarction; Estes, Sokolow, or Cornell criteria for left ventricular hypertrophy; positive Rose questionnaire for angina; and an abnormal Doppler exam for peripheral vascular disease; and 3) neuropathy as assessed by neurological symptom and disability scores, autonomic function testing, and quantitative sensory exams involving thermal and vibratory sensation. Selected patient characteristics were then evaluated to determine their effects on the presence of diabetic complications using univariate analyses. Multiple logistic regression analyses were then performed to determine the independent effect of UAE on these diabetic complications.
chi 2 analyses revealed that UAE was significantly associated with the presence of retinopathy (P < 0.001), neuropathy (P < 0.001), and cardiovascular disease (P < 0.001). In the multiple logistic regression analyses, UAE had strong independent associations with retinopathy, neuropathy, and cardiovascular disease.
Thus, increasing UAE in this large NIDDM population in the U.S. was associated with an increased prevalence of diabetic retinopathy, neuropathy, and cardiovascular disease. This suggests that UAE may be more than an indicator of renal disease in NIDDM patients and, in fact, may reflect a state of generalized vascular damage occurring throughout the body. Prospective studies in NIDDM patients are needed to determine the predictive effect of UAE and the effect of decreasing UAE on future diabetic micro- and macrovascular complications.
在美国的大量人群中，尚未研究非胰岛素依赖型糖尿病（NIDDM）患者尿白蛋白排泄量（UAE）与糖尿病并发症之间的关系。已证实胰岛素依赖型糖尿病（IDDM）患者中UAE增加与视网膜病变、肾病和神经病变的发生有关，这使得该问题在NIDDM患者中也成为一个重要的研究课题。
对主要居住在大都市地区的947例NIDDM患者进行了一项大规模人群研究。将UAE的三类情况，即正常蛋白尿（<20微克/分钟）、微量蛋白尿（20 - 200微克/分钟）和显性蛋白尿（>200微克/分钟）与以下情况进行比较：1）通过立体眼底照片评估的视网膜病变；2）通过心脏病或中风病史评估的心血管疾病；运动平板试验中的缺血性改变；Q波心肌梗死；左心室肥厚的埃斯蒂斯、索科洛夫或康奈尔标准；心绞痛的罗斯问卷阳性；以及外周血管疾病的异常多普勒检查；3）通过神经症状和残疾评分、自主神经功能测试以及涉及热觉和振动觉的定量感觉检查评估的神经病变。然后使用单因素分析评估选定的患者特征，以确定它们对糖尿病并发症存在情况的影响。接着进行多因素逻辑回归分析，以确定UAE对这些糖尿病并发症的独立影响。
卡方分析显示，UAE与视网膜病变（P < 0.001）、神经病变（P < 0.001）和心血管疾病（P < 0.001）的存在显著相关。在多因素逻辑回归分析中，UAE与视网膜病变、神经病变和心血管疾病有很强的独立关联。
因此，在美国这个大量的NIDDM人群中，UAE增加与糖尿病视网膜病变、神经病变和心血管疾病的患病率增加有关。这表明UAE在NIDDM患者中可能不仅仅是肾病的一个指标，实际上可能反映了全身发生的广泛性血管损伤状态。需要对NIDDM患者进行前瞻性研究，以确定UAE的预测作用以及降低UAE对未来糖尿病微血管和大血管并发症的影响。
