Rossing P, Rossing K, Jacobsen P, Parving H H
Steno Diabetes Center, medicinsk endokrinologisk afdeling.
Ugeskr Laeger. 1996 Oct 14;158(42):5940-3.
Recently, a dramatic decline in the cumulative incidence of diabetic nephropathy (less than 10% after 25 years of diabetes) has been reported in IDDM patients diagnosed between 1961 and 1980. In a clinic based study we assessed recent trends in the incidence of diabetic nephropathy. All 356 patients in whom IDDM was diagnosed before the age of 41 years between 1965 and 1979, identified in 1984 were followed to 1991 or to death. The cumulative incidence of diabetic nephropathy (urinary albumin excretion 300 mg/24 hours in two out of three consecutive samples) after 15 years of diabetes and in 1991 were (cumulative incidence (SE)): 18 (4)% and 35 (5)% (onset of diabetes 1965-69, n = 113), 20 (4)% and 35 (5)% (onset of diabetes 1970-74, n = 130), and 16 (5)% (onset of diabetes 1975-79, n = 113), respectively (ns). The mean (SE) haemoglobin A1c measured yearly beginning in 1984 was higher in patients with nephropathy (9.4 (0.1)%), and persistent microalbuminuria (8.9 (0.1)%) than in patients with normoalbuminuria (8.5 (0.1)%, (p < 0.001)). Our study revealed no decline in the cumulative incidence of diabetic nephropathy with increasing calendar year of diabetes onset. This may in part be explained by poor metabolic control and a high prevalence of smokers (58-71%).
最近，有报道称1961年至1980年间确诊的胰岛素依赖型糖尿病（IDDM）患者中，糖尿病肾病的累积发病率急剧下降（糖尿病25年后低于10%）。在一项基于诊所的研究中，我们评估了糖尿病肾病发病率的近期趋势。1984年确定的所有在1965年至1979年间41岁之前被诊断为IDDM的356例患者，随访至1991年或直至死亡。糖尿病15年后及1991年时糖尿病肾病（连续三个样本中有两个样本的尿白蛋白排泄量≥300mg/24小时）的累积发病率（累积发病率（标准误））分别为：18（4）%和35（5）%（糖尿病发病于1965 - 1969年，n = 113）、20（4）%和35（5）%（糖尿病发病于1970 - 1974年，n = 130）以及16（5）%（糖尿病发病于1975 - 1979年，n = 113）（无显著差异）。从1984年开始每年测量的平均（标准误）糖化血红蛋白A1c，肾病患者（9.4（0.1）%）和持续性微量白蛋白尿患者（8.9（0.1）%）高于正常白蛋白尿患者（8.5（0.1）%，（p < 0.001））。我们的研究显示，随着糖尿病发病年份的增加，糖尿病肾病的累积发病率并未下降。这可能部分是由于代谢控制不佳以及吸烟者比例较高（58 - 71%）所致。
