Microalbuminuria in type 1 diabetes: Rates, risk factors and glycemic threshold
Microalbuminuria in type 1 diabetes: Rates, risk factors and glycemic threshold
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DOI：
10.1046/j.1523-1755.2001.00789.x
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发表时间：
2001-07-01
影响因子：
19.6
通讯作者：
Fuller, JH
中科院分区：
文献类型：
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作者：
Chaturvedi, N;Bandinelli, S;Fuller, JH
背景1型糖尿病患者发生微量白蛋白尿是肾脏和心血管疾病的强预测因素，尽管血糖控制得到改善，但仍有可能发生。需要更好地了解微量白蛋白尿，以告知新的干预措施。我们在EURODIAB前瞻性并发症研究中确定了微量白蛋白尿[白蛋白排泄率（AER）20 - 200 mug/min]的发病率和危险因素。这是一个为期7年的随访（1988年至1991年）的1134名正常白蛋白尿的男性和女性（年龄15至60岁）的I型糖尿病从31个欧洲中心。集中测量危险因素和AER。在7.3年中，微量白蛋白尿的发生率为12.6%。独立的基线风险因素为HbA（lc）（7.1 vs. 6.2%）。P = 0.0001）和AER（9.6 vs. 7.8 mug/min，P = 0.0001），以及独立于这些的空腹甘油三酯（0.99 vs. 0.88 mmol/L，P = 0.01）、低密度脂蛋白胆固醇（3.5 vs. 3.2 mmol/L，P = 0.02）。体重指数（24.0 vs. 23.4 kg/m2，P = 0.01）和腰臀比（WHR; 0.85 vs. 0.83，P = 0.009）。在预测微量白蛋白尿方面，甘油三酯和腰臀比危险因素几乎与AER一样强（甘油三酯和腰臀比的标准回归效应为1.3，AER为1.5）。在随访时，血压，但不是在基线，也提高了那些谁进展。没有证据表明HbA（lc）对微量白蛋白尿风险的阈值。1型糖尿病患者微量白蛋白尿的发生率较高，且无明显的血糖阈值，胰岛素抵抗标志物如甘油三酯和腰臀比是其重要的危险因素。在微量白蛋白尿发作之前，全身血压不会升高。
Background. The occurrence of microalbuminuria in type 1 diabetes is strongly predictive of renal and cardiovascular disease and is still likely to occur despite improvements in glycemic control. A better understanding of microalbuminuria is required to inform new interventions. We determined the incidence and risk factors for microalbuminuria [albumin excretion rate (AER) 20 to 200 mug/min] in the EURODIAB Prospective Complications Study.Methods. This is a seven-year follow-up (between 1988 and 1991) of 1134 normoalbuminuric men and women (aged 15 to 60) with type I diabetes from 31 European centers. Risk factors and AER were measured centrally.Results. The incidence of microalbuminuria was 12.6% over 7.3 years. Independent baseline risk factors were HbA(lc) (7.1 vs. 6.2%. P = 0.0001) and AER (9.6 vs. 7.8 mug/min, P = 0.0001) and, independent of these, fasting triglyceride (0.99 vs. 0.88 mmol/L, P = 0.01), low-density lipoprotein cholesterol (3.5 vs. 3.2 mmol/L, P = 0.02). body mass index (24.0 vs. 23.4 kg/m(2), P = 0.01), and waist to hip ratio (WHR; 0.85 vs. 0.83, P = 0.009). Triglyceride and WHR risk factors were nearly as strong as AER in predicting microalbuminuria (standardized regression effects of 1.3 for triglyceride and WHR and 1.5 for AER). Blood pressure at follow-up, but not at baseline, was also raised in those who progressed. There was no evidence of a threshold of HbA(lc) on microalbuminuria risk.Conclusions. The incidence of microalbuminuria in patients with type 1 diabetes remains high, and there is no apparent glycemic threshold for it. Markers of insulin resistance, such as triglyceride and WHR, are strong risk factors. Systemic blood pressure is not raised prior to the onset of microalbuminuria.