Agewall S, Wikstrand J, Ljungman S, Fagerberg B
Department of Medicine, Sahlgrenska University Hospital, Göteborg University, Sweden.
Am J Cardiol. 1997 Jul 15;80(2):164-9. doi: 10.1016/s0002-9149(97)00312-3.
In the present study we report on the predictive power of microalbuminuria for total and cardiovascular mortality in a prospective study (mean follow up 6.3 years) of treated hypertensive men, aged 50 to 72 years, with (n = 94) and without (n = 345) maturity onset diabetes mellitus. Thirty-three (35.1%) of the hypertensive patients with diabetes mellitus died during the follow-up period compared with 57 patients (16.5%) in the hypertensive group without diabetes mellitus (p <0.0002). In those with diabetes mellitus and hypertension, a log-rank test revealed a lower cardiovascular mortality in the normoalbuminuric group compared with both the microalbuminuric (p = 0.035) and the macroalbuminuric group (p = 0.002). The logarithm of urinary albumin excretion was a predictor of both total (p = 0.009) and cardiovascular (p = 0.001) mortality during the follow-up period using Cox regression analysis. This relation remained significant even after adjustment for other risk factors. HbA1c was also an independent predictor of total and cardiovascular mortality. In patients without diabetes mellitus, the small group of patients with macroalbuminuria had a markedly increased cardiovascular mortality compared with both the microalbuminuric (p <0.0001) and the normoalbuminuric groups (p <0.0001). No difference was observed between the normoalbuminuric and the microalbuminuric groups. Smoking at entry and concomitant cardiovascular disease at entry were independent predictors of cardiovascular mortality in these patients. We conclude that microalbuminuria was an independent predictor for cardiovascular mortality in treated hypertensive men with maturity onset diabetes mellitus. Macroalbuminuria, but not microalbuminuria, predicted cardiovascular mortality in nondiabetic treated hypertensive men.
在本研究中，我们报告了在一项对年龄在50至72岁接受治疗的高血压男性进行的前瞻性研究（平均随访6.3年）中，微量白蛋白尿对全因死亡率和心血管死亡率的预测能力，这些患者中有（n = 94）和没有（n = 345）成年型糖尿病。在随访期间，94例糖尿病高血压患者中有33例（35.1%）死亡，而无糖尿病的高血压组中有57例（16.5%）死亡（p<0.0002）。在患有糖尿病和高血压的患者中，对数秩检验显示，与微量白蛋白尿组（p = 0.035）和大量白蛋白尿组（p = 0.002）相比，正常白蛋白尿组的心血管死亡率较低。使用Cox回归分析，尿白蛋白排泄对数是随访期间全因死亡率（p = 0.009）和心血管死亡率（p = 0.001）的预测指标。即使在调整其他危险因素后，这种关系仍然显著。糖化血红蛋白也是全因死亡率和心血管死亡率的独立预测指标。在无糖尿病患者中，与微量白蛋白尿组（p<0.0001）和正常白蛋白尿组（p<0.0001）相比，少量大量白蛋白尿患者的心血管死亡率显著增加。正常白蛋白尿组和微量白蛋白尿组之间未观察到差异。入组时吸烟和入组时合并心血管疾病是这些患者心血管死亡率的独立预测指标。我们得出结论，微量白蛋白尿是成年型糖尿病治疗高血压男性心血管死亡率的独立预测指标。大量白蛋白尿而非微量白蛋白尿可预测非糖尿病治疗高血压男性的心血管死亡率。
