Mulec H, Blohmé G, Grände B, Björck S
Department of Nephrology, Northern Alvsborg County Hospital, Trollhättan, Sweden.
Nephrol Dial Transplant. 1998 Mar;13(3):651-5. doi: 10.1093/ndt/13.3.651.
Strict glycaemic control has been shown to reduce the risk of developing diabetic nephropathy. In established nephropathy, however, the impact of glycaemic control on prognosis is less clear. Therefore we investigated the effect of long-term glycaemic control on the decline in renal function in insulin-dependent diabetic patients with overt nephropathy.
The study was performed at two hospital-based diabetes centres in western Sweden. The study was an observational retrospective follow-up study in 158 insulin-dependent diabetics with proteinuria with a mean (+/-SD) age of 36+/-9 years and a diabetes duration of 22+/-8 years. The change in glomerular filtration rate was measured as 51Cr EDTA clearance for a median of 8 years (range 1-17). Glycaemic control was determined with measurements of glycated haemoglobin A1c.
The decline in glomerular filtration rate was 3.8+/-3.7 ml/min/year. The blood pressure was 143/82+/-15/7 mmHg and the mean glycated haemoglobin was 8.7+/-1.6%. The correlation coefficient between glycated haemoglobin and decline in glomerular filtration rate was -0.39 (P<0.0001 ) and between decline in glomerular filtration rate and systolic and diastolic blood pressure -0.17 (P=0.03) and -0.29 (P=0.003) respectively. In patients with glycated haemoglobin <8.0% and diastolic blood pressure <85 mmHg the decline in glomerular filtration rate was 1.7+/-2.3 ml/min/year.
In this retrospective observational study, effective blood-pressure control was associated with a low rate of decline in renal function and a low urinary albumin excretion. The correlation between glycaemic control and decline in renal function indicates that poor glycaemic control can accelerate the loss of renal function in diabetic nephropathy.
严格的血糖控制已被证明可降低患糖尿病肾病的风险。然而，在已确诊的肾病中，血糖控制对预后的影响尚不清楚。因此，我们研究了长期血糖控制对胰岛素依赖型显性肾病患者肾功能下降的影响。
该研究在瑞典西部的两个医院糖尿病中心进行。这是一项对158名胰岛素依赖型蛋白尿糖尿病患者的观察性回顾性随访研究，患者平均（±标准差）年龄为36±9岁，糖尿病病程为22±8年。肾小球滤过率的变化通过51Cr乙二胺四乙酸清除率进行测量，中位数为8年（范围1 - 17年）。通过测量糖化血红蛋白A1c来确定血糖控制情况。
肾小球滤过率下降为3.8±3.7毫升/分钟/年。血压为143/82±15/7毫米汞柱，平均糖化血红蛋白为8.7±1.6%。糖化血红蛋白与肾小球滤过率下降之间的相关系数为 -0.39（P<0.0001），肾小球滤过率下降与收缩压和舒张压之间的相关系数分别为 -0.17（P = 0.03）和 -0.29（P = 0.003）。在糖化血红蛋白<8.0%且舒张压<85毫米汞柱的患者中，肾小球滤过率下降为1.7±2.3毫升/分钟/年。
在这项回顾性观察研究中，有效的血压控制与肾功能下降率低和尿白蛋白排泄量低相关。血糖控制与肾功能下降之间的相关性表明，血糖控制不佳会加速糖尿病肾病患者肾功能的丧失。
