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1型糖尿病病人的微量白蛋白尿与早期肾功能下降
Bruce A. Perkins*,, Linda H. Ficociello*, Betsy E. Ostrander*, Kristen H. Silva*, Janice Weinberg, James H. Warram*, and Andrzej S. Krolewski*,,||
* Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center, Boston University School of Public Health, Harvard School of Public Health, || Department of Medicine, Harvard Medical School, Boston, Massachusetts; and Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
Address correspondence to: Dr. Andrzej S. Krolewski, Section on Genetics and Epidemiology, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. Phone: 617-732-2668; Fax: 617-732-2667; E-mail: andrzej.krolewski@joslin.harvard.edu
Received for publication August 17, 2006. Accepted for publication January 18, 2007.
This study aimed to establish the time of initiation and the determinants of renal function decline in type 1 diabetes. Until now, such decline has been assumed to be a late-occurring event associated with proteinuria. A total of 267 patients with normoalbuminuria and 301 patients with microalbuminuria were followed for 8 to 12 yr. Linear trends (slopes) in GFR were estimated by serial measurement of serum cystatin C. Cases of early renal function decline were defined by loss in cystatin C GFR that exceeded –3.3%/yr, a threshold that corresponds to the 2.5th percentile of the distribution of GFR slopes in an independent nondiabetic normotensive population. Cases of early renal function decline occurred in 9% (mean slope –4.4; range –5.9 to –3.3%/yr) of the normoalbuminuria group and 31% (mean slope –7.1; range –23.8 to –3.3%/yr) of the microalbuminuria group (P < 0.001). Risk for early renal function decline depended on whether microalbuminuria regressed, remained stable, or progressed, rising from 16 to 32 and 68%, respectively (P < 0.001). In multivariate analysis, risk for decline was higher after age 35 yr or when glycosylated hemoglobin exceeded 9% but did not vary with diabetes duration, smoking, BP, or angiotensin-converting enzyme inhibitor treatment. Contrary to the existing paradigm of diabetic nephropathy, progressive renal function decline in type 1 diabetes is an early event that occurs in a large proportion of patients with microalbuminuria. Together with testing for microalbuminuria, clinical protocols using cystatin C to diagnose early renal function decline and track response to therapeutic interventions should be developed. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 题目：1型糖尿病的微量白蛋白尿与早期肾功能下降的风险
作者：Bruce A. Perkins*,, Linda H. Ficociello*, Betsy E. Ostrander*, Kristen H. Silva*, Janice Weinberg, James H. Warram*, and Andrzej S. Krolewski*,,||节选自流行病学和遗传学研究处，Joslin 糖尿病研究中心，波斯顿大学公共卫生学院，哈佛大学公共卫生学院 || 哈弗大学、波斯顿、麻萨诸塞州医学部；加拿大安大略省多伦多大学内分泌科
相关地址：Dr. Andrzej S. Krolewski, Section on Genetics and Epidemiology, Joslin Diabetes Center, One Joslin Place, Boston, MA 02215. Phone: 617-732-2668; Fax: 617-732-2667; E-mail: andrzej.krolewski@joslin.harvard.edu
2006年8月17号投稿，2007年1月18号录用。
此项研究旨在确定1型糖尿病患者开始出现肾功能下降的时间和肾功能下降的决定因素。到目前为止，肾功能下降被认为出现在蛋白尿的晚期。共随访了267名无蛋白尿患者和301名微量白蛋白尿患者8-12年。GFR的线性变化用血清抑半胱氨酸蛋白酶蛋白C的变化来评价。早期肾功能下降被界定为抑半胱氨酸蛋白酶蛋白C的肾小球滤过率下降超过3.3% /年，此界限对应于非糖尿病非高血压人群的GFR分布曲线的2.5%处。无白蛋白尿组和微量白蛋白尿组肾功能下降发生率分别为9%（平均GFR下降率为4.4%/年，从3.3%/年到5.9%/年不等）和31%（平均GFR下降率为7.1%/年，从3.3%/年到23.8%/年不等）.早期肾功能下降的风险取决于微量白蛋白尿是改善、不变还是恶化，三种情况下肾功能发生率分别为16%、32%、68%（P < 0.001）。经多变量分析可发现肾功能下降风险在35岁以后或糖化血红蛋白超过9%时肾功能下降的风险增加，与糖尿病的时间、吸烟、血压、ACEI的应用无关。与典型糖尿病肾病的患者相比，大部分有微量蛋白尿的1型糖尿病患者早期即可出现进行性肾功能下降，有必要建立利用抑半胱氨酸蛋白酶蛋白C和蛋白尿一同来诊断早期肾功能下降和对治疗介入后的跟踪随访的医疗协议。
刚开始进行翻译，可能有好多翻译不妥之处，欢迎指点！ 具体可参考3.14本版其他战友的译文及本人的点评。
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作者:admin@医学,生命科学 2010-12-25 05:11
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