EPIDEMIOLOGY OF PERSISTENT PROTEINURIA IN TYPE-II DIABETES-MELLITUS - POPULATION-BASED STUDY IN ROCHESTER, MINNESOTA
EPIDEMIOLOGY OF PERSISTENT PROTEINURIA IN TYPE-II DIABETES-MELLITUS - POPULATION-BASED STUDY IN ROCHESTER, MINNESOTA
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DOI：
10.2337/diabetes.37.4.405
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发表时间：
1988-04-01
期刊：
影响因子：
7.7
通讯作者：
PALUMBO, PJ
中科院分区：
文献类型：
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作者：
BALLARD, DJ;HUMPHREY, LL;PALUMBO, PJ
在美国明尼苏达州罗切斯特市的一项基于人群的研究中，对1945年至1969年间首次确诊的糖尿病居民（发病队列）进行了肾病临床危险因素评估。通过社区完整的医疗记录对1031名患有非胰岛素依赖型糖尿病（NIDDM）的罗切斯特居民进行了随访，直至1982年1月1日。在NIDDM确诊时，持续性蛋白尿的患病率为8.2%。在那些最初无持续性蛋白尿的患者中，后续发病率为15.3/1000人年。糖尿病确诊20年后，持续性蛋白尿的累积发病率为24.6%。比例风险模型确定了NIDDM中持续性蛋白尿的以下危险因素：初始空腹血糖升高（P <.01）；糖尿病发病年龄较大（P <.01）；男性（P =.05）；以及在糖尿病确诊时存在大血管疾病（P =.05）、糖尿病视网膜病变（P =.05）或糖尿（P =.07）。对达到年龄进行控制的单独分析表明，NIDDM的病程与持续性蛋白尿的发病率之间没有关联。对两个最显著的危险因素（空腹血糖和年龄）进行分层分析表明，高血糖在较年轻的糖尿病患者中是蛋白尿的更强危险因素，也许是因为老年糖尿病患者存在死亡的竞争风险。与最近描述的丹麦胰岛素依赖型糖尿病患者蛋白尿的长期下降趋势相反，在这个NIDDM发病队列中，过去40年蛋白尿风险没有下降。
Clinical risk factors for nephropathy, were assessed in a population-based study of Rochester, Minnesota [USA], residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort). The 1031 Rochester residents with non-insulin-dependent diabetes mellitus (NIDDM) were followed through their complete medical records in the community to 1 January 1982. The prevalence of persistent proteinuria was 8.2% at the diagnosis of NIDDM. Among those initially free of persistent proteinuria, the subsequent incidence was 15.3/1000 person-yr. Twenty years after the diagnosis of diabetes, the cumulative incidence of persistent proteinuria was 24.6%. A proportional hazards model identified the following risk factors for persistent proteinuria in NIDDM: elevated initial fasting blood glucose (P < .01); older age at onset of diabetes (P < .01); male gender (P = .05); and presence of macrovascular disease (P = .05), diabetic retinopathy (P = .05), or glycosuria (P = .07) at the diagnosis of diabetes. Separate analyses controlling for attained age indicated no association between duration of NIDDM and the incidence of persistent proteinuria. Stratified analysis of the two most significant risk factors (fasting blood glucose and age) indicated that hyperglycemia was a stronger risk factor for proteinuria in younger diabetic subjects, perhaps because of a competing risk of death in the elderly diabetic patient. In contrast to a recently described decreasing secular trend of proteinuria in Danish insulin-dependent diabetes mellitus patients, there was no decrease over the past 40 yr in proteinuria risk in this NIDDM incidence cohort.