对伴微量白蛋白尿2型糖尿病患者动脉粥样硬化的早期干预

160例2型糖尿病患者分为微量白蛋白尿组(MAU组)42例和正常白蛋白尿组(NAU组)118例.多元逐步回归提示微量白蛋白尿与臂踝脉搏波传播速度(baPWV)和颈动脉内中膜厚度(IMT)独立相关(均P＜0.01).西洛他唑干预后,MAU组baPWV显著下降(P＜0.01).     

2型糖尿病伴微量白蛋白尿患者应筛查无症状型心肌缺血

英国Rutter报道,无症状型心肌缺血在无冠心病症状的非胰岛素依赖型糖尿病(NIDDM)病人中常见,尤其更多见于伴微量白蛋白尿者。在该人群中,低运动负荷时缺血反应发生率高,提示将来发生冠脉事件的可能性增加,也表明了患冠心病的概率增大。     

2型糖尿病伴微量白蛋白尿的对策与评价

1　概述微量白蛋白尿(microalbuminuria ,MA)是尿白蛋白排泄率异常增高,但常规试验室检查(尿蛋白测定)阴性。其尿白蛋白排泄率(UAER)为2 0 8～2 0 8 0 μg·min 1(30～30 0mg/d)。1型糖尿病中,MA对显性糖尿病肾病(DN)的预测性使持续的MA成为隐性糖尿病肾病的同义语。早在2 0世纪80年代,人们就注意到1型和2型糖尿病肾病的发生和发展过程有所不同。2型糖尿病MA的发生率与1型糖尿病近似甚至略高,但大量白蛋白尿和终末期肾病的发生率低于1型糖尿病。这提示MA对于1型和2型糖尿病DN的意义可能不同。Schmitz提出可能有两种不同的机制共同…     

尿微量白蛋白检测对2型糖尿病肾病患者的临床意义

目的探究尿微量白蛋白检测对2型糖尿病肾病患者的临床意义。方法回顾性分析2014年1月—2015年1月该院收治的68例2型糖尿病肾病患者临床资料,将其作为研究组,同时选取68例同期行健康体检的正常者作为对照组,检测两组尿微量白蛋白(mAlb),并对检测结果进行分析。结果两组mAlb水平值均处于正常范围内,且研究组mAlb水平值显著高于对照组,差异均具有统计学意义(P0.05);mAlb含量与性别无关,但与患者的病程呈正比例关系。结论尿微量白蛋白可更加准确反映2型糖尿病肾病患者肾功能受损程度,对提前确诊2型糖尿病肾病具指导性意义。     

2型糖尿病患者尿微量白蛋白相关因素分析

将244例T2DM按UAER分成正常白蛋白尿组和微量白蛋白尿两组，对两组患者临床资料进行分析比较，同时将UAER与各指标进行相关分析和多元逐步回归分析。结果：T2DM合并M—UA1b尿组的收张压（SBP）、空腹血糖（FBG）、血尿酸（UA）高于正常白蛋白尿组（P〈0．05），而高密度脂蛋白胆固醇（HDL—C）、载脂蛋白A1（apoA1）低于后者（P〈0．05）；UAER与病程、SBP、血肌酐（Ser）、血尿酸（UA）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）呈正相关，与HDL-C、apoB负相关。结论：SBP、TC、HDL—C为T2DM微量白蛋白尿危险因素。     

2型糖尿病患者尿微量白蛋白相关因素分析

将244例T2DM按UAER分成正常白蛋白尿组和微量白蛋白尿两组，对两组患者临床资料进行分析比较，同时将UAER与各指标进行相关分析和多元逐步回归分析。结果：T2DM合并M—UA1b尿组的收张压（SBP）、空腹血糖（FBG）、血尿酸（UA）高于正常白蛋白尿组（P〈0．05），而高密度脂蛋白胆固醇（HDL—C）、载脂蛋白A1（apoA1）低于后者（P〈0．05）；UAER与病程、SBP、血肌酐（Ser）、血尿酸（UA）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）呈正相关，与HDL-C、apoB负相关。结论：SBP、TC、HDL—C为T2DM微量白蛋白尿危险因素。     

伴微量白蛋白尿的Ⅱ型糖尿病患者动态血压改变

正常人及Ⅰ型糖尿病患者动态血压变化规律国内外已有报道，但对Ⅱ型糖尿病合井有微量白蛋白尿者血压变化规律报道不多。我们应用90207型动态血压监测仪观察30例伴微量白蛋白尿的Ⅱ型糖尿病患者，以了解其血压变化规律。对象和方法我院住院病人50例，均符合WHOⅡ型糖尿病诊断标准。分为两组，A组为尿微量白蛋白排泄率在20～200ug／min者30例，男17例，女13例，平均年龄63．9618．49岁，病程7．85土6．91年，合并高血压者40％（12例）。B组为尿微量白蛋白正常者20例，男女各10例，平均年龄62．45士8．26岁，病程5．26士4．51年，合并高血压…     

2型糖尿病患者微量白蛋白尿与心功能的关系

目的探讨2型糖尿病患者微量白蛋白尿与心功能关系。方法对正常对照、冠心病、2型糖尿病以及2型糖尿病合并冠心病患者甘油三酯、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇等临床生化指标以及左心房直径、射血分数等超声心动图指标进行观察,分析微量白蛋白尿与心功能之间的关系。结果发现微量白蛋白尿水平与射血分数斜率呈现独立正相关,与左心房直径呈现独立负相关。结论 2型糖尿病患者微量白蛋白尿水平与其心功能密切相关。     

2型糖尿病患者微量白蛋白尿缓解的相关因素

目的：评估2型糖尿病患者中微量白蛋白尿缓解的发生率以及研究可能对患者微量白蛋白尿预后产生影响的因素。     

Apolipoprotein H is increased in type 2 diabetic patients with microalbuminuria

BACKGROUND AND AIM: Serum apolipoprotein H (Apo H) levels are increased in hyperlipidemic subjects and type 2 diabetics, but unknown in microalbuminuria, another disorder with an increased cardiovascular risk. We looked to see whether increased Apo H levels are associated with microalbuminuria in type 2 diabetes. METHODS AND RESULTS: Serum Apo H was calculated in 20 normoalbuminuric and 17 microalbuminuric type 2 diabetics matched for age, sex, body mass index (BMI), glycosylated haemoglobin, plasma lipids and duration of diabetes, and also compared with 20 non-diabetic controls matched for age, sex, BMI and plasma lipids. Mean serum Apo H was significantly higher in the microalbuminuric patients (31.12 +/- 1.58 SEM vs 25.25 +/- 1.52 and 24.72 +/- 0.99 mg/dL, p = 0.003). CONCLUSION: Serum apo H levels are increased in type 2 diabetics with microalbuminuria.     

Serum lipids and lipoproteins in type 2 diabetic patients with persistent microalbuminuria

To investigate whether persistent microalbuminuria is related to altered levels of both lipids and apolipoproteins in Type 2 diabetes mellitus serum total-cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, apolipoprotein A-I, and apolipoprotein B were measured by standard methods in a group of Type 2 diabetic patients affected by persistent microalbuminuria (albumin excretion rate (AER) 20-200 micrograms min-1) as compared with a group of sex- and age-matched non-microalbuminuric patients (AER less than 20 micrograms min-1). The groups were stratified according to a short (less than or equal to 5 years) or a longer (greater than 5 years) duration of diagnosed diabetes. Microalbuminuria was not associated with significant changes of serum total-cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, and apolipoproteins in the group of patients with a duration of disease greater than 5 years, while microalbuminuric patients less than or equal to 5 years from diagnosis (n = 11) had serum total-cholesterol, triglycerides, LDL-cholesterol, and apoprotein B higher than non-microalbuminuric control patients (n = 26) (cholesterol 6.2 +/- 0.9 vs 5.1 +/- 1.0 mmol l-1 (p = 0.003); triglycerides 2.1 +/- 0.7 vs 1.7 +/- 1.3 mmol l-1 (p = 0.03); LDL-cholesterol 4.1 +/- 0.8 vs 3.0 +/- 0.7 mmol l-1 (p less than 0.001); apo-B 1.3 +/- 0.3 vs 1.1 +/- 0.3 g l-1 (p = 0.02). In these patients with shorter duration of diabetes many of the serum lipid measures correlated positively with AER.     

2型糖尿病微量白蛋白尿与氧化应激的关系

目的探讨2型糖尿病患者微量白蛋白尿与氧化应激状态的关系。方法将72例2型糖尿病患者分为无微量白蛋白尿的糖尿病组（DM组）和伴有微量白蛋白尿的糖尿病肾病组（DN组）,选择30例无糖尿病患者作正常对照组（NGT组）,测定三组的血清丙二醛（MDA）水平、生化指标及年龄、身高、体质量指数。结果DN组MDA水平明显高于NGT组及DM组,MDA水平与尿微量白蛋白排泄率（UAER）有显著相关性。结论与无微量白蛋白尿的糖尿病患者相比,糖尿病肾病患者存在着严重的氧化应激状态,这可能与UAER的严重程度相关。     

Effects of amlodipine fosinopril combination on microalbuminuria in hypertensive type 2 diabetic patients

BACKGROUND: The aim of this study is to compare the long-term effect of amlodipine and fosinopril in monotherapy or in combination on urinary albumin excretion (UAE) in hypertensive diabetic patients. METHODS: We selected 453 hypertensive patients with type 2 diabetes and microalbuminuria and randomized them to amlodipine (5 to 15 mg/day), fosinopril (10 to 30 mg/day), or amlodipine plus fosinopril (5/10 to 15/30 mg/day) for a 3-month titration period. The nonresponder patients or those complaining of side effects during the titration period were discontinued (n = 144); the remaining 309 patients were enrolled in the trial and treated with the same therapy for 4 years. Every 6 months, blood pressure (BP), heart rate (HR), UAE, creatinine clearance, and glycosylated hemoglobin (HbA1c) were evaluated. RESULTS: The combination therapy was more effective in reducing BP than either drug alone at any time of the study without affecting glucose homeostasis. All three treatments provided a significant decrease in UAE during the 48-month study period. However, this effect was more pronounced and became evident earlier with fosinopril than with amlodipine monotherapy (after 3 v 18 months of therapy). In addition, the combination therapy provided a greater antialbuminuric effect than the single drugs. This could be due to the greater antihypertensive effects, although other drug-specific effects cannot be excluded. The cardiovascular outcomes were similar in the amlodipine and in the fosinopril group, but they were lower in the combination group. CONCLUSIONS: These results strengthen the rationale to use a calcium-antagonist/angiotensin converting enzyme inhibitor combination in the treatment of hypertensive patients with type 2 diabetes.     

2型糖尿病微量白蛋白尿患者血浆血小板活化因子的检测及其临床意义

目的研究2型糖尿病微量白蛋白尿患者血浆血小板活化因子(PAF)的水平及其与尿白蛋白排泄率(UAER)的相互关系.方法采用生物学方法和放免法分别测定30例健康人(正常对照组)、30例2型糖尿病正常白蛋白尿患者、28例2型糖尿病微量白蛋白尿患者血浆PAF和UAER水平.结果 (1)正常对照组与正常白蛋白尿组相比UAER、血浆PAF均无显著性差异(P>0.05);(2)在排除代谢因素影响后,2型糖尿病组中微量白蛋白尿组与正常白蛋白尿组相比血浆PAF有非常显著性差异(P<0.01);(3)UAER与PAF正相关,相关系数0.68,尤其在微量白蛋白尿组,相关系数达0.74.结论血浆PAF增高可能参与了2型糖尿病微量白蛋白尿的发生、发展过程,它的检测可作为早期糖尿病肾病的诊断、治疗、预后观察的一个临床指标.     

Increased plasma thrombin-activatable fibrinolysis inhibitor levels in normotensive type 2 diabetic patients with microalbuminuria

Hypofibrinolysis is a common finding in patients with diabetes mellitus and a risk factor for diabetic nephropathy. Recently, a new potent inhibitor of fibrinolysis, the thrombin-activatable fibrinolysis inhibitor (TAFI), has been isolated from human plasma. The possibility that TAFI also participates in the mechanism of hypofibrinolysis has not been appraised in diabetic patients with microalbuminuria. In the present study, we investigated the plasma levels of TAFI and its relation to urinary albumin excretion in normotensive diabetic patients with normo- and microalbuminuria. Thirty-nine normotensive nonobese type 2 diabetic patients (27 with normoalbuminuria, 12 with microalbuminuria) and 20 age-matched normal subjects were enrolled in this study. The plasma level of thrombin-antithrombin complex was significantly increased (22.1 +/- 2.6 vs. 8.3 +/- 1.0 nmol/liter; P < 0.05), whereas the D-dimer/thrombin-antithrombin complex ratio was significantly decreased (15.7 +/- 1.4 vs. 26.5 +/- 2.2; P < 0.05), showing the occurrence of hypercoagulability and hypofibrinolysis in diabetic patients. The plasma level of TAFI in diabetic patients was significantly elevated, compared with normal subjects (147.4 +/- 11.6 vs. 99.5 +/- 4.9%; P < 0.05). The plasma level of TAFI in diabetic patients with microalbuminuria was significantly higher than the level in diabetic patients with normoalbuminuria (194.1 +/- 24.5 vs. 128.8 +/- 12.3%; P < 0.02) or normal subjects (194.1 +/- 24.5 vs. 99.5 +/- 4.9%; P < 0.005). Univariate analysis showed that the plasma TAFI levels are significantly and proportionally correlated with urinary albumin excretion rate (r = 0.58; P < 0.005) and with plasma soluble thrombomodulin level, a marker of endothelial cell damage, in all diabetic patients (r = 0.42; P < 0.01). These data suggest that increased plasma level of TAFI may be involved in the mechanism of vascular endothelial damage in patients with type 2 diabetes mellitus.     

Elevated serum leptin concentrations in type 2 diabetic patients with microalbuminuria and macroalbuminuria.

Leptin levels are elevated in end-stage renal disease, suggesting an impairment of renal leptin degradation. The present study aimed to determine whether leptin levels are also elevated in patients with earlier stages of renal disease, ie, microalbuminuric and macroalbuminuric nephropathy. A total of 60 subjects were assigned to two study groups. Group A contained 10 type 2 diabetics with macroalbuminuria, 10 type 2 diabetics with normoalbuminuria, and 10 healthy control subjects. Group B contained 10 type 2 diabetics with microalbuminuria, 10 type 2 diabetics with normoalbuminuria, and 10 healthy controls. The subgroups of both study groups were matched for sex and body fatness. In group A, macroalbuminuric diabetic patients had higher serum leptin levels than the normoalbuminuric diabetics (11.90 +/- 2.98 v 4.13 +/- 0.92 ng/mL, P < .002) and control subjects (4.78 +/- 1.37 ng/mL, P < .006). In group B, microalbuminuric diabetics had higher serum leptin levels than the normoalbuminuric diabetics (21.16 +/- 5.80 v8.74 +/- 1.89 ng/mL, P < .04) and control subjects (10.06 + 3.00 ng/mL, P < .06). In both groups A and B, creatinine clearance was inversely correlated with the serum leptin level after adjusting for body fat. In conclusion, serum leptin levels are elevated in type 2 diabetic patients with microalbuminuria and macroalbuminuria, suggesting that renal leptin degradation is already impaired in the early stages of renal disease.     

Preventing microalbuminuria in patients with type 2 diabetes

The public health burden of type 2 diabetes mellitus has been dramatically increasing world-wide. The chronic complications of type 2 diabetes play an important role in decreasing life expectancy and adversely affecting quality of life. Diabetic nephropathy, which is originally microvascular in nature, is widely considered an important complication of diabetes. In prospective clinical investigations, increased urinary albumin excretion proved to be associated not only with subsequent renal outcomes but also with cardiovascular morbidity/mortality independently of other risk factors. Therefore, microalbuminuria as an early sign of increased urinary albumin excretion should be considered important for both treatment and even for prevention. Preventing microalbuminuria might diminish progression to overt nephropathy and, hopefully, might limit cardiovascular events. Regarding primary prevention of diabetic nephropathy, therapeutic intervention should optimally be initiated at the stage of normoalbuminuria. Although additional factors such as smoking cessation, reduction of protein intake, and treatment of lipid abnormalities are important, providing optimal diabetic control as well as targeting optimal blood pressure are the key elements of a prevention strategy in diabetic patients. Recently, the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) documented that a significant decrease of the development of persistent microalbuminuria could be achieved by using an ACE-inhibitor, trandolapril alone or in combination with verapamil SR, a non-dihydropyridine calcium-channel blocker in hypertensive type 2 diabetic patients with normoalbuminuria. The results of this primary-prevention strategy should be corroborated by further investigations to determine whether these beneficial changes could later result in improvement of renal clinical outcomes, macrovascular complications, or both.