Considerations about the threshold value of microalbuminuria in patients with diabetes mellitus: lessons from an 8-year follow-up study of 599 patients
Considerations about the threshold value of microalbuminuria in patients with diabetes mellitus: lessons from an 8-year follow-up study of 599 patients
复制标题
DOI：
10.1016/s0168-8227(00)00155-8
复制
发表时间：
2000-08-01
影响因子：
5.1
通讯作者：
Ravid, M
中科院分区：
文献类型：
--
作者：
Rachmani, R;Levi, Z;Ravid, M
目的：通过对599例血压正常、基线白蛋白排泄率（AER）≤ 30 mg/24 h的2型糖尿病患者8年随访资料的分析，探讨尿微量白蛋白（30 mg/24 h）的时间阈值的有效性。患者：根据RER基线值将患者分为三组。组I：0-10 mg/24 h;组II：10.1-20 mg/24 h;组III：20.1-30 mg/24 h。结果：在随访期间，第I、II和III组分别有25.3%、47.3%和85.3%的患者进展为微量白蛋白尿。与I组相比，II组患者进展为微量白蛋白尿的风险为2.34（95% CI 1.32-4.43，P = 0.029），III组为12.36（95% CI 8.9-16.5，P = 0.0001）。三组肾小球滤过率（GFR）平均每年下降分别为1.19、1.64和2.52 ml/min。基线AER值和随后GFR下降之间的相关性呈指数关系，没有明确的阈值。与I组相比，任何心血管终点（如死亡、非致死性心肌梗死等）的比值比均显著高于I组。IT组患者为1.9（95%，CI 0.8-2.5，P = 0.22），III组为9.8（95% CI 6.7-12.3，P = 0.001）。结论：本研究表明，基线AER值为20.1 - 30 mg/24 h的患者显示GFR加速下降，心血管事件的风险显著高于AER值低于20 mg/24 h的患者。尽管AER显然是一个连续变量，但筛选和预防策略的任意阈值可能应设定为20 mg/24 h，而不是30 mg/24 h。(C)2000爱思唯尔科学爱尔兰有限公司保留所有权利。
Objective: To examine the validity of the time honored threshold value for microalbuminuria of 30 mg/24 h, by analyzing an 8-year follow-up data of 599 patients with diabetes mellitus type 2, normal blood pressure and base-line albumin excretion rate (AER) less than or equal to 30 mg/24 h. Patients: The patients were allocated to three groups according to the baseline values of RER. Group I: 0-10 mg/24 h; Group II: 10.1-20 mg/24 h; Group III: 20.1-30 mg/24 h. Results: Progression to microalbuminuria during follow-up occurred in 25.3, 47.3 and 85.3% of the patients in Group I, II and III, respectively. Compared to Group I, the risk to progress to microalbuminuria was 2.34 (95% CI 1.32-4.43, P = 0.029) in patients of Group II and 12.36 (95% CI 8.9-16.5, P = 0.0001) in Group III. The average annual decline in glomerular filtration rate (GFR) was 1.19, 1.64 and 2.52 ml/min per year, respectively in the three groups. The correlation between baseline AER values and subsequent decline in GFR was exponential without a clear threshold value. Compared to Group I, the odds ratio for any cardiovascular end point (e.g. death, non-fatal myocardial infarction etc.) \was 1.9 (95%, CI 0.8-2.5, P = 0.22) for patients of Group IT and 9.8 (95% CI 6.7-12.3, P = 0.001) for Group III. Conclusions: The present study shows that patients with baseline AER values of 20.1 30 mg/24 h show an accelerated decline in GFR and significantly higher risk for cardiovascular events than patients with AER values below 20 mg/24 h. Though AER is obviously a continuous variable, the arbitrary threshold value For screening and For preventive strategics should probably be set at 20 rather than at 30 mg/24 h. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.