Incidence of proteinuria in type 2 diabetes mellitus in the Pima Indians.
Incidence of proteinuria in type 2 diabetes mellitus in the Pima Indians.
复制标题
皮马印第安人 2 型糖尿病蛋白尿的发病率。
作者：
Charles L. Kunzelman;W. Knowler;D. Pettitt;P. Bennett
人们对2型(非胰岛素依赖型)糖尿病肾病的自然病史知之甚少，但在美国，2型糖尿病是终末期肾病的主要原因。在参与糖尿病及其并发症的纵向人群研究的皮马印第安人中，确定了重度蛋白尿的发生率。重度蛋白尿的定义是尿蛋白(g/L)与尿肌酐(g/L)的比值大于或等于1.0(大于或等于113 mg蛋白质/nmoL肌酐)，这一水平对应于大约1g/天的尿蛋白排泄率。在糖尿病确诊后0~5年、5~10年、10~15年和15~20年期间，糖尿病PIMA患者蛋白尿的发生率分别为4、12、37和106例/千人年。5年、10年、15年和20年的累积发病率分别为2%、8%、23%和50%。糖尿病病程、由高血糖程度和治疗类型决定的糖尿病严重程度以及血压是蛋白尿的危险因素。大量蛋白尿的出现与肾功能不全的发展密切相关，肾功能不全的定义是血清肌酐大于或等于2.0毫克/分升(大于或等于177摩尔/升)。皮马印第安人2型糖尿病中蛋白尿的发生率与其他人群中报道的1型糖尿病的发病率一样高，是这种疾病的一种常见的严重并发症。
Little is known of the natural history of nephropathy in type 2 (non-insulin-dependent) diabetes, yet type 2 diabetes is a major cause of end-stage renal disease in the United States. The incidence rate of heavy proteinuria was determined in Pima Indians participating in a longitudinal population study of diabetes and its complications. Heavy proteinuria was defined by a urine protein (g/liter) to urine creatinine (g/liter) ratio greater than or equal to 1.0 (greater than or equal to 113 mg protein/nmol creatinine), a level which corresponds to a urine protein excretion rate of about 1 g/day. The incidence rates of proteinuria in diabetic Pimas were 4, 12, 37, and 106 cases/1,000 person-years at risk in the periods 0 to 5, 5 to 10, 10 to 15, and 15 to 20 years after the diagnosis of diabetes. The cumulative incidence rates were 2%, 8%, 23%, and 50% at 5, 10, 15, and 20 years, respectively. The duration of diabetes, severity of diabetes as determined by the degree of hyperglycemia and type of treatment, and blood pressure were risk factors for proteinuria. The presence of heavy proteinuria was strongly associated with the development of renal insufficiency, defined by serum creatinine greater than or equal to 2.0 mg/dl (greater than or equal to 177 mumol/liter). The incidence of proteinuria in type 2 diabetes in Pima Indians was as high as that reported in type 1 diabetes in other populations and represents a frequent, serious complication of the disease.