Progression of diabetic nephropathy
Progression of diabetic nephropathy
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DOI：
10.1046/j.1523-1755.2001.059002702.x
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发表时间：
2001-02-01
影响因子：
19.6
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Hovind, P;Rossing, P;Parving, HH
背景资料。糖尿病肾病是导致肾功能衰竭的主要原因。肾小球滤过率(GFR)的下降是高度可变的，范围从2到20，中位数为12毫升/分钟/年。丧失滤过性能力的风险因素(促进剂)尚未明确确定。此外，有关最佳动脉血压、血糖控制和胆固醇水平的信息也很缺乏。我们在1983年至1997年间连续收集了301例1型糖尿病合并糖尿病肾病患者，连续7年(3~14年)，每年测定GFR、血压、蛋白尿、糖化血红蛋白A(1c)和血清胆固醇。如果满足以下标准，则临床诊断为糖尿病肾病：持续性蛋白尿和GT；200µg/min，存在糖尿病视网膜病变。也没有其他肾脏或肾道疾病的证据。总体而言。271例患者在观察期末接受降压治疗。平均动脉压102+/-0.4(东南)毫米汞柱。在30例血压持续正常的患者中，GFR平均下降4.0+/-0.2毫升/分/年，甚至更低(1.9+/-0.5毫升/分/年)，这些患者中没有一人接受过降压治疗(P<；0.01)。多元线性回归分析显示，肾小球滤过率的下降与平均动脉压、蛋白尿、糖化血红蛋白A(1c)、血清胆固醇呈显著正相关(R-adj(2)=0.29，P<0.001)。没有显示出血压、糖化血红蛋白A(1c)或血清胆固醇的阈值水平。平均动脉压和糖化血红蛋白A(1c)低于和高于中位数(分别为102毫米汞柱和9.2%)的两次打击模型显示，最低层的肾小球滤过率下降速度仅为1.5mL/分钟/年，而最高层为6.1mL/分钟/年(P<；0.001)。在过去的几十年中，糖尿病肾病的预后有所改善，这主要是因为有效的降压治疗。真正的血压正常的患者肾病进展缓慢。几个可修改的变量已被确定为进步促进剂。
Background. Diabetic nephropathy is a major cause of renal failure. The decline in glomerular filtration rate (GFR) is highly variable, ranging from 2 to 20, with a median of 12 mL/min/ year. The risk factors of losing filtration power (progression promoters) have not been clearly identified. Furthermore, information on optimal arterial blood pressure, glycemic control, and cholesterol levels are lacking.Methods. We measured GFR with Cr-51-EDTA plasma clearance technique, blood pressure, albuminuria, glycosylated hemoglobin A(1c), and serum cholesterol every year for seven years (range 3 to 14 years) in 301 consecutive type 1 diabetic patients with diabetic nephropathy recruited consecutively during 1983 through 1997. Diabetic nephropathy was diagnosed clinically if the following criteria were fulfilled: persistent albuminuria >200 mug/min, presence of diabetic retinopathy. and no evidence of other kidney or renal tract disease. In total. 271 patients received antihypertensive treatment at the end of the observation period.Results. Mean arterial blood pressure was 102 +/- 0.4 (SE) mm Hg. The average decline in GFR was 4.0 +/- 0.2 mL/min/year and even lower(1.9 +/- 0.5 mL/min/year) in the 30 persistently normotensive patients, none of whom had ever received antihypertensive treatment (P < 0.01). A multiple linear regression analysis revealed a significant positive correlation between the decline in GFR and mean arterial blood pressure, albuminuria, glycosylated hemoglobin A(1c), and serum cholesterol during follow-up (R-adj(2) = 0.29, P less than or equal to 0.001). No threshold level for blood pressure, glycosylated hemoglobin A(1c), or serum cholesterol was demonstrated. A two-hit model with mean arterial blood pressure and glycosylated hemoglobin A(1c) below and above the median values (102 mm Hg and 9.2%, respectively) revealed a rate of decline in GFR of only 1.5 mL/min/year in the lowest stratum compared with 6.1 mL/min/year in the highest stratum (P < 0.001).Conclusions. The prognosis of diabetic nephropathy has improved during the past decades, predominantly because of effective antihypertensive treatment. Genuine normotensive patients have a slow progression of nephropathy. Several modifiable variables have been identified as progression promoters.