Different risk factors of microangiopathy in patients with Type I diabetes mellitus of short versus long duration. The EURODIAB IDDM Complications Study
Different risk factors of microangiopathy in patients with Type I diabetes mellitus of short versus long duration. The EURODIAB IDDM Complications Study
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DOI：
10.1007/s001250050053
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发表时间：
2000-03-01
期刊：
影响因子：
8.2
通讯作者：
Fuller, JH
中科院分区：
文献类型：
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作者：
Karamanos, B;Porta, M;Fuller, JH
目标/假设。确定与I型(胰岛素依赖型)糖尿病患者微血管并发症的早期发生和晚期保护相关的因素。对300例病程短(小于或等于5年)的I型糖尿病患者和1062例病程长(大于或等于14年)的I型糖尿病患者的微血管并发症发生率及其与危险因素的关系进行了研究。微血管疾病被定义为存在视网膜病变(从中央分级的视网膜照片中评估)或尿白蛋白排泄率超过20微克/分钟。短期组的微血管病变患病率为25%。在长期组中，18%的患者没有微血管并发症的证据。在短病程组中，与早期并发症发生相关的因素是吸烟和高血压家族史。糖尿病病程长但无微血管并发症的受试者血糖控制较好，血压较低，血脂谱较好，von Willebrand因子水平较低。在I型糖尿病的早期阶段，吸烟和高血压的遗传易感性是微血管并发症的重要危险因素。在以后的阶段，额外的危险因素是血糖控制较差，血压较高，以及可能与内皮功能障碍有关的不良血脂谱。这些因素中有许多是长期干预的结果，应在发病过程中尽快开始干预。
Aims/hypothesis. To identify factors associated with early development of and late protection from microvascular complications in subjects with Type I (insulin-dependent) diabetes mellitus.Methods. The frequency of microvascular complications and their relation to risk factors were studied in 300 Type I diabetic subjects with short duration of disease (less than or equal to 5 years) compared with 1062 subjects with long duration (greater than or equal to 14 years). Microvascular disease was defined as the presence of either retinopathy (assessed from centrally-graded retinal photographs) or urinary albumin excretion rate of more than 20 mu g/min.Results. The prevalence of microvascular disease was 25 % in the short duration group. In the long duration group 18 % had no evidence of microvascular complications. In the short duration group factors associated with early development of complications were cigarette smoking and a family history of hypertension. Subjects free of microvascular complications in spite of long duration of diabetes had better glycaemic control, lower blood pressure, better lipid profile and lower von Willebrand factor levels.Conclusion/interpretation. At the early stages of Type I diabetes, cigarette smoking and genetic susceptibility to hypertension are important risk factors for microvascular complications. At a later stage, additional risk factors are poorer glycaemic control, higher blood pressure, and an unfavourable lipid profile possibly associated with endothelial dysfunction. Many of these factors are amenable to long-term intervention which should be started as soon as possible in the course of the disease.