Mykkänen L, Zaccaro D J, O'Leary D H, Howard G, Robbins D C, Haffner S M
Department of Medicine, University of Texas Health Science Center at San Antonio 78284-7873, USA.
Stroke. 1997 Sep;28(9):1710-6. doi: 10.1161/01.str.28.9.1710.
Microalbuminuria is associated with cardiovascular mortality in subjects with non-insulin-dependent diabetes mellitus (NIDDM). However, little is known about this association in nondiabetic subjects. Specifically, it is not known whether microalbuminuria is related to an early stage of atherosclerosis manifested as increased intima-media thickness (IMT) of carotid arteries. We investigated the relationship between microalbuminuria and carotid artery IMT in 991 nondiabetic and 450 NIDDM subjects aged 40 to 69 years.
Microalbuminuria was defined as albumin-to-creatinine ratio > or = 2 mg/mmol in a morning spot urine sample. B-mode ultrasound was used to assess the IMT of the common and internal carotid arteries.
Altogether 13.9% of nondiabetic and 27.6% of NIDDM subjects had microalbuminuria, and 31.1% of nondiabetic and 50.8% of NIDDM subjects had hypertension. Subjects with microalbuminuria had greater common carotid artery (CCA) IMT than those without microalbuminuria (nondiabetic: 0.84 +/- 0.02 versus 0.80 +/- 0.01 mm, P = .010; NIDDM: 0.89 +/- 0.02 versus 0.86 +/- 0.01 mm, P = .152; combined: 0.86 +/- 0.01 versus 0.82 +/- 0.01, P = .005). The association of microalbuminuria and CCA IMT was independent of age, sex, ethnicity, smoking, and lipoprotein levels. Although further adjustment for hypertension in the multivariate linear regression analysis attenuated the difference in CCA IMT between subjects with and without microalbuminuria, this difference continued to be significant (combined: 0.86 +/- 0.01 versus 0.83 +/- 0.01, P = .015). In contrast to CCA IMT, microalbuminuria was not related to ICA IMT.
Microalbuminuria was associated with increased CCA IMT. This relationship was only partly mediated by hypertension. Thus, microalbuminuria is related to atherosclerosis at an early stage of the disease process.
微量白蛋白尿与非胰岛素依赖型糖尿病（NIDDM）患者的心血管死亡率相关。然而，对于非糖尿病患者中这种关联的了解甚少。具体而言，尚不清楚微量白蛋白尿是否与以颈动脉内膜中层厚度（IMT）增加为表现的动脉粥样硬化早期阶段有关。我们调查了991名年龄在40至69岁的非糖尿病患者和450名NIDDM患者中微量白蛋白尿与颈动脉IMT之间的关系。
微量白蛋白尿定义为晨尿样本中白蛋白与肌酐比值≥2mg/mmol。使用B型超声评估颈总动脉和颈内动脉的IMT。
共有13.9%的非糖尿病患者和27.6%的NIDDM患者有微量白蛋白尿，31.1%的非糖尿病患者和50.8%的NIDDM患者有高血压。有微量白蛋白尿的患者颈总动脉（CCA）IMT大于无微量白蛋白尿的患者（非糖尿病患者：0.84±0.02对0.80±0.01mm，P = 0.010；NIDDM患者：0.89±0.02对0.86±0.01mm，P = 0.152；合并：0.86±0.01对0.82±0.01，P = 0.005）。微量白蛋白尿与CCA IMT的关联独立于年龄、性别、种族、吸烟和脂蛋白水平。尽管在多变量线性回归分析中进一步调整高血压减弱了有和无微量白蛋白尿患者之间CCA IMT的差异，但这种差异仍然显著（合并：0.86±0.01对0.83±0.01，P = 0.015）。与CCA IMT相反，微量白蛋白尿与颈内动脉（ICA）IMT无关。
微量白蛋白尿与CCA IMT增加有关。这种关系仅部分由高血压介导。因此，微量白蛋白尿与疾病过程早期的动脉粥样硬化有关。
