A NATIONWIDE CROSS-SECTIONAL STUDY OF URINARY ALBUMIN EXCRETION RATE, ARTERIAL BLOOD-PRESSURE AND BLOOD-GLUCOSE CONTROL IN DANISH CHILDREN WITH TYPE-1 DIABETES-MELLITUS
A NATIONWIDE CROSS-SECTIONAL STUDY OF URINARY ALBUMIN EXCRETION RATE, ARTERIAL BLOOD-PRESSURE AND BLOOD-GLUCOSE CONTROL IN DANISH CHILDREN WITH TYPE-1 DIABETES-MELLITUS
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DOI：
10.1111/j.1464-5491.1990.tb01324.x
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发表时间：
1990-12-01
影响因子：
3.5
通讯作者：
PARVING, HH
中科院分区：
文献类型：
--
作者：
MORTENSEN, HB;MARINELLI, K;PARVING, HH
在丹麦的22个治疗1型糖尿病儿童的儿科部门进行了全国范围的微量白蛋白尿筛查。在6个月的时间里，对1020名儿童（12岁）和青少年（> 12至19岁）进行了筛查（占总数的81%）。其中，957例（94%）进行了至少两次定时过夜尿液采集。在209例非糖尿病受试者中，正常白蛋白排泄率（AER）的95%上限为20 μg min−1。与糖尿病儿童（1.7 x/次; 2.1 μg min−1）和非糖尿病儿童（1.3 x/次; 2.2 μg min −1）相比，糖尿病青少年（3.0 x/次; 2.3（SD耐受因子）μg min − 1）和非糖尿病青少年（2.5 x/次; 2.2 μg min− 1）的平均夜间AER显著升高（p< 0.001）。糖尿病患者AER与体表面积、年龄呈正相关。在1型糖尿病患者中，4.3%（18名男性和23名女性）的AER > 20至150 μg min−1（持续性微量白蛋白尿）。另有7名青少年（0.7%）有明显的蛋白尿（> 150 μg min−1）。将41例AER > 20 - 150 μg min− 1的糖尿病患者的临床数据与569例AER 20 μg min− 1且糖尿病病程超过2年的糖尿病青少年患者的临床数据进行比较。AER > 20 - 150 μg min− 1组的平均年龄（16.5岁）显著高于AER 20 μg min−1组（15.0岁;p< 0.001）。AER > 20 - 150 μg min− 1的女性平均HbA 1c水平（10.8 ± 1.9%）显著高于AER 20 μg min−1的女性（9.8 ± 1.9%，p < 0.03）;她们的线性生长也受损（标准差评分-0.25 vs + 0.16;p= 0.003）。在男性中未发现这些相关性。与AER 20 μg min− 1的糖尿病患者（女性20.8 ± 3.0 kg m−2，p= 0.02;男性19.7 ± 2.4 kg m−2，p< 0.006）相比，AER > 20 - 150 μ g min − 1的女性（22.2 ± 2.9 kg m −2）和男性（20.8 ± 2.7 kg m −2）的平均体重指数（BMI）显著增加。AER > 20 - 150 μg min− 1的糖尿病患者组的平均血压（94 ± 9 mmHg）显著高于AER 20 μg min − 1的糖尿病患者组（87 ± 9 mmHg;p< 0.0001）。糖尿病患者和663名非糖尿病健康儿童的对照组之间的平均血压或BMI无统计学显著差异。研究结果表明，青春期的激素变化，血糖控制不良（特别是女性）和动脉血压升高可能是与糖尿病儿童微量白蛋白尿患病率增加相关的危险因素。
Nation‐wide screening for microalbuminuria in Denmark was performed in 22 paediatric departments treating children with Type 1 diabetes. Over a period of 6 months 1020 children ( 12 years) and adolescents (> 12 to 19 years) were screened (81% of total). Of these, 957 (94%) performed at least two timed overnight urine collections. In 209 non‐diabetic subjects the upper 95% limit for normal albumin excretion rate (AER) was 20 μg min−1. Mean overnight AER was significantly (p< 0.001) elevated in diabetic (3.0 x/divide; 2.3 (SD tolerance factor) μg min−1) and in non‐diabetic (2.5 x/ divide; 2.2 μg min−1) adolescents compared with diabetic (1.7 x/ divide; 2.1 μg min−1) and non‐diabetic (1.3 x/ divide; 2.2 μg min−1) children. In the diabetic patients AER was positively correlated with the body surface area and age. Among the patients with Type 1 diabetes, 4.3% (18 males and 23 females) had AER > 20 to 150 μg min−1(persistent microalbuminuria). A further 7 adolescents (0.7%) had overt proteinuria (> 150 μg min−1). Clinical data for the 41 diabetic patients with AER > 20 to 150 μg min−1were compared with those for 569 diabetic adolescents with AER 20 μg min−1and duration of diabetes more than 2 years. The group with AER > 20 to 150 μg min−1had significantly higher mean age (16.5 years) than the group with AER 20 μg min−1(15.0 years;p< 0.001). Females with AER > 20 to 150 μg min−1had significantly higher mean HbA1clevel (10.8 ± 1.9%) than those with AER 20 μg min−1(9.8 ± 1.9%,p< 0.03); they also had impaired linear growth (standard deviation score −0.25 vs + 0.16;p= 0.003). These associations were not found in males. Mean body mass index (BMI) was significantly increased in both females (22.2 ± 2.9 kg m−2) and males (20.8 ± 2.7 kg m−2) with AER > 20 to 150 μg min−1, compared with diabetic patients with AER 20 μg min−1(females 20.8 ± 3.0 kg m−2,p= 0.02; males 19.7 ± 2.4 kg m−2,p< 0.006). Mean blood pressure was significantly higher (94 ± 9 mmHg) in the group of diabetic patients with AER > 20 to 150 μg min−1than in the group with AER 20 μg min−1(87 ± 9 mmHg;p< 0.0001). No statistically significant differences in mean blood pressure or BMI were found between the diabetic patients and a control group of 663 non‐diabetic healthy children. The findings suggest that hormonal changes in puberty, poor blood glucose control (particularly in females), and elevated arterial blood pressure may be risk factors related to the increased prevalence of microalbuminuria in diabetic children.