Mattock M B, Barnes D J, Viberti G, Keen H, Burt D, Hughes J M, Fitzgerald A P, Sandhu B, Jackson P G
Department of Diabetes, United Medical and Dental Schools of Guy's and St. Thomas' Hospital, London, UK.
Diabetes. 1998 Nov;47(11):1786-92. doi: 10.2337/diabetes.47.11.1786.
In most survival studies in NIDDM, microalbuminuria (urinary albumin excretion rate 20-200 microg/min) predicts early mortality; in cross-sectional studies, it is associated with coronary heart disease (CHD) morbidity. It is unclear, however, whether microalbuminuria is a risk factor for the development of CHD or the result of it, and little is known of the factors that predispose to the development of microalbuminuria in NIDDM. We examined these issues in a 7-year prospective study of a hospital-based cohort comprising 146 white NIDDM patients without clinical albuminuria. Microalbuminuria was a significant risk factor for both all-cause mortality (relative risk 3.94, 95% CI 2.04-7.62) and CHD mortality (relative risk 7.40, 95% CI 2.94-18.7) when adjusted for age only. Its independent predictive power did not persist, however, in age-adjusted multivariable survival analysis that allowed for the other significant risk factors: male sex, preexisting CHD, high levels of glycated hemoglobin, and high serum cholesterol. Among men free of CHD at baseline, the independent risk factors for CHD morbidity and mortality were microalbuminuria, current smoking, high diastolic blood pressure, and high serum cholesterol (all P < 0.05). For the 100 NIDDM patients with normoalbuminuria at baseline, the incidence of microalbuminuria was 29% over the 7-year period. In that group, fasting plasma glucose, current smoking, preexisting CHD, and high initial urinary albumin excretion rate were risk factors for the development of microalbuminuria (all P < 0.05). When men and women were analyzed separately, preexisting CHD was a significant risk factor in men only. These results demonstrate that microalbuminuria predicts incident clinical CHD in men with NIDDM. Preexisting CHD is also a risk factor for incident microalbuminuria in men, however, suggesting that microalbuminuria and CHD are not causally related but rather reflect common determinants.
在大多数非胰岛素依赖型糖尿病（NIDDM）的生存研究中，微量白蛋白尿（尿白蛋白排泄率为20 - 200微克/分钟）可预测早期死亡率；在横断面研究中，它与冠心病（CHD）的发病率相关。然而，目前尚不清楚微量白蛋白尿是冠心病发生的危险因素还是其结果，并且对于非胰岛素依赖型糖尿病中易导致微量白蛋白尿发生的因素知之甚少。我们在一项为期7年的前瞻性研究中对一个以医院为基础的队列进行了调查，该队列由146名无临床白蛋白尿的白人非胰岛素依赖型糖尿病患者组成。仅对年龄进行调整时，微量白蛋白尿是全因死亡率（相对风险3.94，95%可信区间2.04 - 7.62）和冠心病死亡率（相对风险7.40，95%可信区间2.94 - 18.7）的显著危险因素。然而，在考虑了其他显著危险因素（男性、既往冠心病、糖化血红蛋白水平高和血清胆固醇高）的年龄调整多变量生存分析中，其独立预测能力并未持续存在。在基线时无冠心病的男性中，冠心病发病和死亡的独立危险因素为微量白蛋白尿、当前吸烟、高舒张压和高血清胆固醇（所有P < 0.05）。对于基线时尿白蛋白正常的100名非胰岛素依赖型糖尿病患者，在7年期间微量白蛋白尿的发生率为29%。在该组中，空腹血糖、当前吸烟、既往冠心病和高初始尿白蛋白排泄率是微量白蛋白尿发生的危险因素（所有P < 0.05）。当分别对男性和女性进行分析时，既往冠心病仅是男性发生微量白蛋白尿的显著危险因素。这些结果表明，微量白蛋白尿可预测非胰岛素依赖型糖尿病男性患者发生临床冠心病。然而，既往冠心病也是男性发生微量白蛋白尿的危险因素，这表明微量白蛋白尿和冠心病并非因果相关，而是反映了共同的决定因素。
