De Cosmo S, Bacci S, Piras G P, Cignarelli M, Placentino G, Margaglione M, Colaizzo D, Di Minno G, Giorgino R, Liuzzi A, Viberti G C
Division of Endocrinology, IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, Italy.
Diabetologia. 1997 Oct;40(10):1191-6. doi: 10.1007/s001250050806.
Life expectancy is shorter in the subset of insulin-dependent diabetic (IDDM) patients who are susceptible to kidney disease. Familial factors may be important. In this study the prevalence of cardiovascular disease mortality and morbidity and of risk factors for cardiovascular disease was compared in the parents of 31 IDDM patients with elevated albumin excretion rate (AER > 45 microg/min; group A) with that of parents of 31 insulin-dependent diabetic patients with normoalbuminuria (AER < 20 microg/min; group B). The two diabetic patient groups were matched for age and duration of disease. Information on deceased parents was obtained from death certificates and clinical records and morbidity for cardiovascular disease was ascertained using the World Health Organization questionnaire and Minnesota coded ECG. Hyperlipidaemia was defined as serum cholesterol higher than 6 mmol/l and/or plasma triglycerides higher than 2.3 mmol/l and/or lipid lowering therapy; arterial hypertension as systolic blood pressure higher than 140 mmHg and/or diastolic blood pressure higher than 90 mmHg and/or antihypertensive treatment. The percentage of dead parents was similar in the two groups (26 vs 20% for parents of group A vs group B, respectively), but the parents of the diabetic patients with elevated AER had died at a younger age (58 +/- 10 vs 70 +/- 14 years; p < 0.05). Parents of diabetic patients with nephropathy had a more than three times greater frequency of combined mortality and morbidity for cardiovascular disease than that of the parents of diabetic patients without nephropathy (26 vs 8%; odds ratio 3.96, 95% CI 1.3 to 12.2; p < 0.02). Living parents of group A had a higher prevalence of arterial hypertension (42 vs 14% p < 0.01) and hyperlipidaemia (49 vs 26% p < 0.05) as well as higher levels of lipoprotein (a) [median (range) 27.2 (1-107) vs 15.6 (0.2-98) mg/dl; p < 0.05]. They also had reduced insulin sensitivity [insulin tolerance test: median (range) K(itt) index: 3.7 (0.7-6.2) vs 4.8 (0.7-6.7)% per min; p < 0.05]. In the families of IDDM patients with elevated AER there was a higher frequency of risk factors for cardiovascular disease as well as a predisposition to cardiovascular disease events. This may help explain, in part, the high prevalence of cardiovascular disease mortality and morbidity in those IDDM patients who develop nephropathy.
在易患肾脏疾病的胰岛素依赖型糖尿病（IDDM）患者亚组中，预期寿命较短。家族因素可能很重要。在本研究中，比较了31例白蛋白排泄率升高（AER>45微克/分钟；A组）的IDDM患者的父母与31例正常白蛋白尿（AER<20微克/分钟；B组）的胰岛素依赖型糖尿病患者的父母的心血管疾病死亡率、发病率以及心血管疾病危险因素的患病率。这两组糖尿病患者在年龄和病程方面相匹配。关于已故父母的信息来自死亡证明和临床记录，心血管疾病的发病率通过世界卫生组织问卷和明尼苏达编码心电图确定。高脂血症定义为血清胆固醇高于6毫摩尔/升和/或血浆甘油三酯高于2.3毫摩尔/升和/或降脂治疗；动脉高血压定义为收缩压高于140毫米汞柱和/或舒张压高于90毫米汞柱和/或抗高血压治疗。两组中已故父母的百分比相似（A组和B组父母分别为26%和20%），但AER升高的糖尿病患者的父母死亡年龄较轻（58±10岁对70±14岁；p<0.05）。患有肾病的糖尿病患者的父母心血管疾病合并死亡率和发病率是无肾病糖尿病患者父母的三倍多（26%对8%；优势比3.96，95%可信区间1.3至12.2；p<0.02）。A组在世父母的动脉高血压患病率较高（42%对14%，p<0.01）、高脂血症患病率较高（49%对26%，p<0.05）以及脂蛋白（a）水平较高[中位数（范围）27.2（1-107）对15.6（0.2-98）毫克/分升；p<0.05]。他们的胰岛素敏感性也降低[胰岛素耐量试验：中位数（范围）K（itt）指数：每分钟3.7（0.7-6.2）%对4.8（0.7-6.7）%；p<0.05]。在AER升高的IDDM患者家庭中，心血管疾病危险因素的发生率较高，且易发生心血管疾病事件。这可能部分有助于解释那些发生肾病的IDDM患者中心血管疾病死亡率和发病率较高的原因。
