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【medical-news】1型糖尿病患者微量白蛋白尿和肾功
Author: Perkins BA, Ficociello LH, Ostrander BE, Silva KH, Weinberg J, Warram JH, Krolewski AS.
*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.
Abstract: 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.
PMID: 17329575 [PubMed - as supplied by publisher] 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型糖尿病人微量白蛋白尿与肾功能早期进行性下降的风险
Author: Perkins BA, Ficociello LH, Ostrander BE, Silva KH, Weinberg J, Warram JH, Krolewski AS.
*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.
摘要：本研究目的是揭示1型糖尿病人肾功能下降的起始时间及决定因素。到目前为止，大多数人都推定肾功能下降是与蛋白尿相关的晚期并发症。本研究共随访了267例正常蛋白尿和301例有微量白蛋白尿病人8到12年。通过连续检测血清半胱氨酸蛋白酶抑制物C（Cystatin C）建立了肾小球滤过率（GFR）的变化曲线。以Cystatin C评估GFR下降超过3.3%/年定为早期肾功能下降的标准，以非糖尿病血压正常人群GFR±2.5%为阈值。将267例正常蛋白尿和301例有微量白蛋白尿病人的GRF变化曲线与独立的非糖尿病血压正常人群进行比较，发现肾功能下降在正常蛋白尿组的发生率为9% (平均斜率mean slope -4.4; range -5.9 to -3.3%/yr)。而微量白蛋白尿组病人发生率为31% (平均斜率mean slope -7.1; range -23.8 to -3.3%/yr)。差异有显著统计学意义（P < 0.001）。早期肾功能下降的发生风险与微量白蛋白尿的的消失，稳定 及进展的风险系数分别为16 、32及 68%,(P均 < 0.001). 多变量分析显示：年龄大于35岁，糖基化血红蛋白大于9%均是高危因素，而与糖尿病患病时间，吸烟、血压及血管紧张素转换酶抑制剂的应用无关。本结果与目前存在的糖尿病肾病治疗规范不一致的是，1型糖尿病进行性肾功能下降发生在微量白蛋白尿的病人比例比较高。因此今后应进一步加强检测微量白蛋白尿及用cystatin C来诊断肾功能下降并检验临床治疗效果。 楼上战友的译文整体来说翻译得比较准确，但个别单词的中文意思还不够精准，如establish, estimate,paradigm，assume等，希望校正，也欢迎其他战友点评。 摘要：本研究目的是揭示(寻找[标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-06-10 05:11
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