Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study
Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study
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DOI：
10.1136/bmj.38070.450891.fe
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发表时间：
2004-05-08
影响因子：
105.7
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Hovind, P;Tarnow, L;Parving, HH
目的前瞻性评价1型糖尿病患者发生持续性微量蛋白尿和大量蛋白尿的基线预测因素。设计前瞻性队列研究，在丹麦根托夫特的第三转诊中心设立糖尿病门诊。研究对象：自1979年9月1日至1984年8月31日，286名新诊断的1型糖尿病患者(216名成人)连续入院。主要观察指标为持续性微量蛋白尿和持续性大量蛋白尿。结果在中位时间18.0年(1.0-21.5年)的随访期间，277例患者中79人出现持续性微量蛋白尿。27例进一步发展为持续性大量蛋白尿。持续性微量白蛋白尿和持续性大量白蛋白尿的累积发生率分别为33.6%(95%可信区间27.2%~40.0%)和14.6%(8.9%~20.3%)。持续性微量蛋白尿的显著预测因素(95%可信区间)是尿白蛋白排泄率增加10倍(相对危险度3.78，1.57至9.13)，男性(2.41，1.43至4.06)，平均动脉压增加10毫米汞(1.38，1.20至1.57)，血红蛋白A(1c)增加1%(1.18，1.04至1.32)，身高增加1厘米(0.96，0.95至0.98)。28例(35%)微量白蛋白尿患者一过性(n=15)或永久性(n=13)转为正常白蛋白尿。在糖尿病的头20年内。一些潜在的可改变的危险因素预测持续性微量白蛋白尿和持续性大量白蛋白尿的发展。
Objective To evaluate baseline predictors for the development of persistent microalbuminuria and macroalbuminuria prospectively in patients with type 1 diabetes.Design Prospective observational study of an inception cohort.Setting Outpatient diabetic clinic in a tertiary referral centre, Gentofte, Denmark.Participants 286 patients (216 adults) newly diagnosed with type 1 diabetes consecutively admitted to the clinic between 1 September 1979 and 31 August 1984.Main outcome measures Persistent microalbuminuria and persistent macroalbuminuria.Results During the median follow up of 18.0 years (range 1.0-21.5 years), total of 4706 patient years of follow up, 79 of 277 patients developed persistent microalbuminuria. 27 progressed further to persistent macroalbuminuria. The cumulative incidence of persistent microalbuminuria and persistent macroalbuminuria was 33.6% (95% confidence interval 27.2% to 40.0%) and 14.6% (8.9% to 20.3%), respectively. Significant predictors (95% confidence intervals) for the development of persistent microalbuminuria were a 10-fold increase in urinary albumin excretion rate (relative risk 3.78, 1.57 to 9.13), being male (2.41, 1.43 to 4.06), a 10 mm Hg increase in mean arterial blood pressure (1.38, 1.20 to 1.57), a 1% increase in haemoglobin A(1c) (1.18, 1.04 to 1.32), and a 1 cm increase in height (0.96, 0.95 to 0.98). 28 patients with microalbuminuria (35%) regressed to normoalbuminuria either transiently (n=15) or permanently (n=13).Conclusions Around one third of patients newly diagnosed with type 1 diabetes develop persistent microalbuminuria. within the first 20 years of diabetes. Several potentially modifiable risk factors predict the development of persistent microalbuminuria and persistent macroalbuminuria.