Rudberg S, Osterby R, Dahlquist G, Nyberg G, Persson B
Institute of Experimental Clinical Research, Arhus University, Denmark.
Diabetes Care. 1997 Mar;20(3):265-71. doi: 10.2337/diacare.20.3.265.
To evaluate the impact of glycemic control, blood pressure, lipid levels, glomerular filtration rate (GFR), age, and duration of IDDM on the degree of structural glomerular changes in the transitional stage of microalbuminuria.
Fifteen adolescents (seven boys and eight girls) with > 5 years of duration of IDDM and with low-grade microalbuminuria (15-30 micrograms/min) participated. Seventeen living kidney donors served as healthy control subjects. Five-year mean HbA1c; 5-year mean systolic and diastolic blood pressure; GFR, cholesterol, and triglycerides 2-5 years before renal biopsy; age; and duration of IDDM were investigated and related to basement membrane thickness (BMT), mesangial and matrix volume fractions, and the overall glomerulopathy index [(BMT/10 + mat/glom, %) + matrix star volume].
BMT and the overall diabetic glomerulopathy were increased in diabetic patients as compared with control subjects (P < 0.001), whereas matrix volume fraction, but not mesangial volume fraction, tended to be increased (P = 0.11). In multivariate analysis, BMT was predicted by 5-year mean HbA1c, diabetes duration, and previous GFR (R2 = 0.71, P = 0.003). With matrix volume fraction as the dependent variable, BMT and diabetes duration were the only significant determinants (R2 = 0.63, P = 0.003). Diabetes duration, 5-year mean HbA1c, and GFR were the variables with an independent influence on the overall diabetic glomerulopathy index (R2 = 0.72, P = 0.003). Preceding blood pressure and lipid levels or age had no significant independent influence on these morphometric measures.
In the very early stage of microalbuminuria in IDDM adolescents, a high percentage of the variation in BMT and overall severity of glomerulopathy is explained by prolonged hyperglycemia and diabetes duration. Previous glomerular hyperfiltration may also add to the prediction of these morphological changes.
评估血糖控制、血压、血脂水平、肾小球滤过率（GFR）、年龄及胰岛素依赖型糖尿病（IDDM）病程对微量白蛋白尿过渡阶段肾小球结构改变程度的影响。
15名病程超过5年且伴有低度微量白蛋白尿（15 - 30微克/分钟）的青少年（7名男孩和8名女孩）参与研究。17名活体肾供者作为健康对照。研究了肾活检前5年的平均糖化血红蛋白（HbA1c）；5年的平均收缩压和舒张压；GFR、胆固醇及甘油三酯水平；年龄；以及IDDM病程，并将其与基底膜厚度（BMT）、系膜及基质体积分数以及总体肾小球病变指数[（BMT/10 + 基质/肾小球，%）+ 基质星体积]相关联。
与对照组相比，糖尿病患者的BMT及总体糖尿病性肾小球病变增加（P < 0.001），而基质体积分数有增加趋势，但系膜体积分数无增加（P = 0.11）。多变量分析中，BMT由5年平均HbA1c、糖尿病病程及既往GFR预测（R2 = 0.71，P = 0.003）。以基质体积分数为因变量时，BMT和糖尿病病程是仅有的显著决定因素（R2 = 0.63，P = 0.003）。糖尿病病程、5年平均HbA1c及GFR是对总体糖尿病性肾小球病变指数有独立影响的变量（R2 = 0.72，P = 0.003）。既往血压、血脂水平或年龄对这些形态学指标无显著独立影响。
在IDDM青少年微量白蛋白尿的极早期阶段，BMT及肾小球病变总体严重程度的很大一部分变异可由长期高血糖及糖尿病病程来解释。既往肾小球高滤过也可能有助于预测这些形态学改变。
