More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients.
More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients.
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DOI：
10.2337/dc11-1955
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发表时间：
2012-04
期刊：
影响因子：
16.2
通讯作者：
Tarng DC
中科院分区：
文献类型：
--
作者：
Chen YH;Chen HS;Tarng DC
本研究旨在探讨微量白蛋白尿或中度降低的肾小球滤过率（GFR）是否能更好地预测2型糖尿病患者视网膜病变的发生和进展。在2001年8月1日至2002年12月31日期间登记了无心血管疾病、恶性肿瘤、妊娠和急性合并疾病的2型糖尿病患者。所有参与者都提供了详细的病史，并进行了眼底检查。在门诊随访，每年随访血清肌酐、尿白蛋白与肌酐比值（UACR）和视网膜照片，直至2009年12月31日。主要结局是糖尿病视网膜病变和肾病的发生和进展。次要结局是心血管事件和全因死亡率。在487名参与者中，81名受试者有正常蛋白尿和中度肾功能损害（基线eGFR 30-59.9 mL/min/1.73 m2）， 106名受试者有微量蛋白尿，基线eGFR≥60 mL/min/1.73 m2。多因素调整后，微量白蛋白尿和eGFR≥60 mL/min/1.73 m2的患者与中度肾功能损害和正常白蛋白尿的患者相比，糖尿病视网膜病变发生和进展的风险显著增加（HR 3.34 [95% CI 1.04-10.70]）。肾脏预后、心血管事件和全因死亡率的风险在两组之间没有显著差异。在2型糖尿病患者中，与GFR中度下降相比，微量白蛋白尿对预测糖尿病视网膜病变的发生和进展有更大的影响。
The current study aimed to investigate whether microalbuminuria or moderately decreased glomerular filtration rate (GFR) is a better predictor for the development and progression of retinopathy in type 2 diabetic patients. Type 2 diabetic patients without cardiovascular diseases, malignancy, pregnancy, and acute intercurrent illness were enrolled between 1 August 2001 and 31 December 2002. All participants provided their detailed medical history and underwent an eye fundus examination. They were followed up in outpatient clinics, and serum creatinine, urinary albumin-to-creatinine ratio (UACR), and retinal photographs were followed up annually until 31 December 2009. The primary outcomes were development and progression of diabetic retinopathy and nephropathy. The secondary outcomes were cardiovascular events and all-cause mortality. Among 487 participants, 81 subjects had normoalbuminuria and moderate renal impairment (baseline eGFR 30–59.9 mL/min/1.73 m2), and 106 subjects had microalbuminuria and baseline eGFR ≥60 mL/min/1.73 m2. Patients with microalbuminuria and eGFR ≥60 mL/min/1.73 m2 had a significantly greater risk for development and progression of diabetic retinopathy (HR 3.34 [95% CI 1.04–10.70]) compared with those with moderate renal impairment and normoalbuminuria after multivariate adjustment. Risks for renal outcome, cardiovascular events, and all-cause mortality were not significantly different between the two groups. Microalbuminuria has a greater impact on predicting the development and progression of diabetic retinopathy compared with moderate decline in GFR among type 2 diabetic patients.
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DOI：
10.1056/nejmoa1001288
发表时间：
2010-07-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
ACCORD Study Group;ACCORD Eye Study Group;Chew EY;Ambrosius WT;Davis MD;Danis RP;Gangaputra S;Greven CM;Hubbard L;Esser BA;Lovato JF;Perdue LH;Goff DC Jr;Cushman WC;Ginsberg HN;Elam MB;Genuth S;Gerstein HC;Schubart U;Fine LJ
通讯作者：
Fine LJ
影响因子：
15.9
作者：
Mizutani, M;Kern, TS;Lorenzi, M
通讯作者：
Lorenzi, M
影响因子：
16.2
作者：
MacIsaac, R;Tsalamandris, C;Jerums, G
通讯作者：
Jerums, G
影响因子：
5.1
作者：
Tone, A;Shikata, K;Makino, H
通讯作者：
Makino, H
影响因子：
8.2
作者：
Stratton, IM;Kohner, EM;Matthews, DR
通讯作者：
Matthews, DR