Nelson R G, Morgenstern H, Bennett P H
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Arizona, USA.
Kidney Int. 1998 Dec;54(6):2081-8. doi: 10.1046/j.1523-1755.1998.00191.x.
The risk of proteinuria in Type 1 diabetes declined > or = 30% over the past 50 years, and improvements in metabolic control are believed to be largely responsible. Little is known about secular changes in the risk of proteinuria in Type 2 diabetes.
We examined trends in the incidence rate of proteinuria in Pima Indians > or = 20 years of age with diabetes diagnosed between January 1, 1955 and December 31, 1994.
Among 1305 initially non-proteinuric diabetic subjects, 433 developed proteinuria during a median follow-up of 8.0 years (range 0.8 to 30.2 years). With subjects with diabetes diagnosed between 1955 and 1964 serving as the reference group, the rate of proteinuria was similar (rate ratio 1.0; 95% confidence interval, 0.79 to 1.3) in the cohort diagnosed between 1965 and 1974, 1.5 times as high (95% confidence interval, 1.1 to 2.0) in the cohort diagnosed between 1975 and 1984, and 1.9 times as high (95% confidence interval, 1.1 to 3.0) in the cohort diagnosed between 1985 and 1994, after adjusting for potential confounders in a generalized additive proportional hazards model. Between the first and last cohorts, plasma glucose concentration declined, on average, by 17% (P = 0.0001) and the mean arterial pressure declined by 11% (P = 0.0001).
The incidence rate of proteinuria in Pima Indians with Type 2 diabetes increased nearly twofold in the last 40 years, despite improvements in plasma glucose and blood pressure. Rapidly changing environmental or behavioral factors must play an important role in the pathogenesis of diabetic renal disease in this population.
在过去50年中，1型糖尿病患者蛋白尿风险下降≥30%，人们认为代谢控制的改善在很大程度上对此负责。关于2型糖尿病患者蛋白尿风险的长期变化，人们了解甚少。
我们研究了1955年1月1日至1994年12月31日期间确诊为糖尿病的20岁及以上皮马印第安人蛋白尿发病率的趋势。
在1305名最初无蛋白尿的糖尿病患者中，433人在中位随访8.0年（范围0.8至30.2年）期间出现蛋白尿。以1955年至1964年期间确诊为糖尿病的患者作为参照组，在1965年至1974年期间确诊的队列中，蛋白尿发生率相似（率比1.0；95%置信区间，0.79至1.3），在1975年至1984年期间确诊的队列中高1.5倍（95%置信区间，1.1至2.0），在1985年至1994年期间确诊的队列中高1.9倍（95%置信区间，1.1至3.0），这是在采用广义相加比例风险模型对潜在混杂因素进行校正之后得出的结果。在第一个和最后一个队列之间，血浆葡萄糖浓度平均下降了17%（P = 0.0001），平均动脉压下降了11%（P = 0.0001）。
尽管血浆葡萄糖和血压有所改善，但在过去40年中，2型糖尿病皮马印第安人蛋白尿的发病率几乎增加了一倍。快速变化的环境或行为因素必定在该人群糖尿病肾病的发病机制中发挥重要作用。
