血压对NIDDM患者尿白蛋白排泄的影响

本文对１６４例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者２４ｈ尿白蛋白排泄（２４ｈＵＡＥ）进行检测，结果显示：（１）在病程＜１０年的患者中，伴或不伴高血压者，２４ｈＵＡＥ无显著差异，但伴高血压者，微量白蛋白尿的发生率明显高于不伴高血压者，分别为３６．９％（１／１９）和７．９％（６／７６）；（２）在病程１０－２０年的患者中，伴高血压者，２４ｈＵＡＥ、微量及大量白蛋白尿的发生率均明显高于不伴高血压者；（３     

NIDDM患者尿白蛋白排泄率观察及相关因素探讨

ＮＩＤＤＭ患者尿白蛋白排泄率观察及相关因素探讨于志文，王乐伟，陈颖丽，成瑶，毛腾淑尿白蛋白排泄率（ＡＥＲ）对早期预测和诊断糖尿病肾病有重要意义，作者对在我院诊治的１０７例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者尿ＡＥＲ进行了观察，并初步探讨了其相关因素...     

临界高血压患者动态血压监测及其与尿白蛋白排泄率的关系研究

目的：观察临界高血压患者２４小时动态血压变化及其与尿白蛋白排泄的关系。方法：对５６例临界高血压患者及３０例血压正常对照者进行动态血压监测、冷加压试验及尿白蛋白排泄率的测定。结果：与正常对照者相比,临界高血压患者２４小时昼夜血压差值缩小,小于１０％的百分率明显增加;冷加压试验后血压上升幅度及血浆中儿茶酚胺水平增加;尿白蛋白排泄率增加,并且与２４小时收缩压、舒张压呈正相关,特别是与夜间血压存在明显的正     

高血压病患者尿白蛋白排泄率观察及其相关因素探讨

探讨高血压病患者尿白蛋白排泄率与相关因素关系，方法采用放射免疫法，测定７８例例高血压病患者及６８例正常人的尿ＡＥＲ。结果高血压病患者的尿ＡＥＲ异常民病程，血ＣＨ、ＴＧ、Ｃｒ水平，血压水平及视网膜动脉硬化程度比较呈显著正相关。结论尿ＡＥＲ与高血压的血管病变常见的危险因素有关。     

糖尿病患者尿白蛋白排泄率与骨密度相关性研究

为探讨糖尿病患者尿白蛋白排泄率（AER）与骨密度（BMD）的相关性,测定了106例糖尿病患者和20例正常人（对照组）24小时AER,根据糖尿病患者AER分为Ⅰ组即正常蛋白尿组、Ⅱ组即微量白蛋白尿组、Ⅲ组即大量白蛋白尿组,并分别测定其L2～4椎体、股骨近端BMD。结果显示,除Ⅰ、Ⅱ组男性患者腰椎BMD与对照组无明显差异外,其余各组、各部位BMD与对照组相比均明显下降（P＜0.01）;男女糖尿病AER正常患者分别与同性别对照组相比,其BMD亦降低（P＜0.01）。糖尿病患者中,Ⅲ组BMD明显低于Ⅰ、Ⅱ组（P＜0.05）。提示糖尿病肾病患者BMD比正常人低,大量蛋白尿组BMD较其它组显著下降。     

糖尿病前期尿白蛋白排泄率和微量白蛋白尿患病率的比较

目的　比较糖耐量正常 (NGT)、单纯空腹血糖受损 (I IFG)、单纯糖耐量低减 (I IGT)、糖耐量低减合并空腹血糖受损 (IGT/IFG)、新诊断的 2型糖尿病 (2型DM ) 5种不同糖代谢状态的尿白蛋白排泄率 (UAE)和微量白蛋白尿 (MAU )患病率。方法　根据 75g口服葡萄糖耐量试验 (75gOGTT)结果 ,将 2 93 4例受试者分为 :NGT组 13 3 2例、I IFG组 186例、I IGT组 470例、IGT/IFG组 2 3 6例、新诊断的 2型DM组 710例。用放射免疫法测定过夜 12h尿白蛋白。UAE在 2 0～ 2 0 0μg/min之间定义为MAU。 结果　 (1)UAE水平 [中位数 (四分位数 ) ] ,在新诊断的 2型DM组为8 50 (4 89～ 15 95) μg/min、IGT/IFG组为 6 93 (4 85～ 10 89) μg/min、I IGT组为 6 51(4 0 9～10 74) μg/min ,均高于I IFG组的 5 56(3 70～ 9 2 3 ) μg/min(P值均 <0 0 1) ;I IFG组与NGT组的 5 2 6(3 50～ 8 12 ) μg/min比较差异无显著性 (P >0 0 5) ;MAU的患病率在新诊断的 2型DM组为 2 0 7%、IGT/IFG组为 13 1%、I IGT组为 11 7%、I IFG组为 5 8%、NGT组为 5 6% ,同样呈现上述变化规律。(2 )多元逐步回归分析显示 :UAE与OGTT 2h血糖、舒张压、体重指数呈现独立正相关。logistic回归分析显示 ,导致MAU危险性增加的因素有OGTT 2h血糖、舒张     

临界高血压患者动态血压监测及其与尿白蛋白排泄率的关系研究

目的:观察临界高血压患者24小时动态血压变化及其与尿白蛋白排泄的关系. 方法:对56例临界高血压患者及30例血压正常对照者进行动态血压监测、冷加压试验及尿白蛋白排泄率的测定. 结果:与正常对照者相比,临界高血压患者24小时昼夜血压差值缩小,小于10%的百分率明显增加;冷加压试验后血压上升幅度及血浆中儿茶酚胺水平增加;尿白蛋白排泄率增加,并且与24小时收缩压、舒张压呈正相关,特别是与夜间血压存在明显的正相关关系. 结论:部分临界高血压患者已有早期的肾脏损害,这可能与血压节律改变有关,特别是与夜间血压增高有关..     

老年糖尿病患者尿白蛋白排泄率与缺血性心脏病的关系

老年糖尿病患者尿白蛋白排泄率与缺血性心脏病的关系狄群杨美南南京医科大学第一附属医院老年医学科（２１００２９）表糖尿病组与合并缺血性心脏病组情况对照（ｘ±ｓ）ＮＩＤＤＭ（ｎ＝１７）ＮＩＤＤＭ＋ＩＨＤ（ｎ＝１２）年龄（岁）７２．４４±４．６４７２．６７±...     

NIDDM患者自主神经病变,动态血压与尿白蛋白排泄率的关系

目的 探讨ＮＩＤＤＭ患者自主神经病变与糖尿病肾病的关系。方法 测定了６８例ＮＩＤＤＭ患者的ＨｂＡｌｃ,血脂,２４小时动态血压,尿白蛋白排泄率及自主神经功能。以健康对照心率功能谱变量９５％可信区间作为ＡＮＦ正常参考值,将ＮＩＤＤＭ患者分成伴ＡＮ和无ＡＮ组。结果 伴ＡＮ患者血压,心率,ＵＡＥＲ２４小时均值显著高于无ＡＮ组,其昼夜变异率显著低于ＡＮ组,且伴ＡＮ患者血压和相应ＵＡＥＲ相关性更好。     

不同年龄组糖尿病患者尿白蛋白排泄率的相关因素分析

目的 研究不同年龄组糖尿病患者尿白蛋白排泄率（ＵＡＥＲ）的变化及可能的因素。方法 分析４９７便不同年龄组糖尿病患者（ＵＡＥＲ）变化及相关因素。结果 随着年龄增加，肾病（ＤＮ）与视网病变（ＤＲ）共存的比例增大，两种病及不存在的比例上，ＤＮ与ＤＲ存在的一致性随年龄增加而减弱，三组相关系数比较有显著性差异，结论老年糖尿病患者ＵＡＥＲ的影响因素较复杂。     

胰岛素短期强化治疗对血、尿内皮素和尿白蛋白排泄率的影响

对32例尿白蛋白排泄率（UAER）增高的初诊2型糖尿病患者行胰岛素短期强化治疗,血糖下降平稳2周后与治疗前比较,FBG、FA、HOMA-IR、HOMA-β、UAER、UET-1、SET-1的差异均有统计学意义,FBG、HOMA-IR分别与UAER、UET-1与SET-1呈显著的正相关。胰岛素强化治疗能改善高血糖引起的内皮功能障碍、降低UAER并改善胰岛素抵抗。     

Albumin excretion rate levels in non-diabetic offspring of NIDDM patients with and without nephropathy

Summary Familial clustering of diabetic nephropathy points to genetic susceptibility. The observation that in non-diabetic subjects microalbuminuria occurs more frequently in the presence of a parental history of diabetes supports this hypothesis. However, the role of inherited factors is poorly understood in non-insulin dependent diabetes mellitus (NIDDM). This study investigated the albumin excretion rate in non-diabetic offspring of NIDDM patients with increased albumin excretion rate (>20 g/min) or normal albumin excretion rate (<20 g/min). We recruited 20 offspring of NIDDM patients with increased albumin excretion rate (A-off) and 20 offspring of NIDDM patients with normal albumin excretion rate (N-off), matched for age, sex, body mass index, blood pressure and estimated protein intake. All offspring were normotensive, had normal creatinine clearance, normal glucose tolerance and sterile urine collection. Albumin excretion rate was measured on three sterile overnight urine collections and median values were used for calculations. Albumin excretion rate was significantly higher in A-off than in N-off (7.7±1.2 vs 3.4±0.6 g/min p<0.01) and significantly related to parents' albumin excretion rate (p<0.01, r=0.53). These results suggest that an increased glomerular permeability is present in non-diabetic offspring of NIDDM patients with increased albumin excretion rate.Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - AER albumin excretion rate - OGTT oral glucose tolerance test - A-off offspring of NIDDM patients with increased albumin excretion rate - N-off offspring of NIDDM patients without increased albumin excretion rate     

The acute effect of insulin on heart rate,blood pressure,plasma noradrenaline and urinary albumin excretion

Summary The effect of intravenous insulin (7–8 U as a bolus injection) on renal haemodynamics and urinary excretion of albumin and beta-2-microglobulin was examined in five recent onset juvenile diabetics. Blood glucose concentration was maintained after insulin at unchanged or slightly increased levels by continuous intravenous glucose infusion (50 g/100 ml, 1.2 ml/min). Mean arterial blood pressure increased slightly but significantly from 94±8 mmHg to 99±10 (mean ± SD) after insulin. The rise in heart rate (16 versus 29 beats/min) and in plasma noradrenaline (from 0.16 to 0.32 ng/ml versus 0.20 to 0.49 ng/ml) was significantly greater in the tilted position after insulin. There was no decrease in glomerular filtration rate or renal plasma flow after insulin, in contrast to the findings after intravenous injection of insulin without maintenance of plasma glucose. Urinary albumin excretion was approximately doubled after insulin, from 6.8 to 12.5 g/min. Beta-2-microglobulin excretion decreased but this difference was not significant. — It is concluded that the rise in heart rate and plasma noradrenaline, and the increase in urinary albumin excretion, after insulin, are unrelated to changes in blood glucose concentration. It is suggested that increased albumin excretion after insulin is due to a direct effect of insulin on glomerular endothelial or epithelial cells.     

Urinary albumin excretion and 24-hour blood pressure as predictors of pre-eclampsia in Type I diabetes

Aims/hypothesis. To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus.¶Methods. The study included 136 consecutive pregnancies in Caucasian women with Type I diabetes before gestation without diabetic nephropathy, anamnestic hypertension or early abortion. Values of urinary albumin excretion and office blood pressure before pregnancy and the HbA_1C value at the time of conception were obtained. Microalbuminuria was defined as urinary albumin excretion of 30–300 mg/24 h in two out of three consecutive urine samples. Single measurements of 24-h urinary albumin excretion, office blood pressure and HbA_1C were done five 5 times during pregnancy. In a subgroup of 74 women 24-h blood pressure measurements were done at 10 and 28 weeks of gestation. Pre-eclampsia was defined as office blood pressure higher than 140/90 mm Hg accompanied by proteinuria above 0.3 g/24 h later than 20 weeks of gestation.¶Results. Urinary albumin excretion and systolic blood pressure were higher before and throughout pregnancy in 14 women developing pre-eclampsia compared with women remaining normotensive (p < 0.001; p < 0.05, respectively). By logistic regression analysis the best predictor for pre-eclampsia was microalbuminuria before pregnancy (p < 0.05) with no additive predictive effect of 24-h blood pressure or office blood pressure measurement. The night:day ratio of blood pressure was similar in the two groups.¶Conclusion/interpretation. Microalbuminuria before pregnancy is the strongest predictor of pre-eclampsia in Type I diabetes. Measuring 24-h blood pressure early in pregnancy did not improve the ability to identify women at risk. [Diabetologia (2000) 43: 927–931]     

Urinary albumin excretion rate and 24-h ambulatory blood pressure in NIDDM with microalbuminuria: effects of a monounsaturated-enriched diet

Summary Previous studies have shown that unsaturated fat-enriched diets may have a beneficial effect on blood pressure in non-insulin-dependent diabetic (NIDDM) patients, whereas little is known about the effects on albuminuria. In a 3-week cross-over design we compared the effects of a currently recommended high-carbohydrate diet (50% carbohydrate, 30% fat [10% monounsaturated fat]) vs a diet rich in monounsaturated fat (30% carbohydrate, 50% fat [30% monounsaturated fat]) on urinary albumin excretion rate, 24-h ambulatory blood pressure and metabolic control in ten NIDDM patients with persistent microalbuminuria. The 24-h ambulatory blood pressure was similar before and after both the high-carbohydrate diet (mean±SD: 145/78±25/10 vs 143/79±19/10 mmHg (NS) and the monounsaturated fat diet: 140/78±16/8 vs 143/79±15/8 mmHg (NS). No changes were observed in day or night-time blood pressures. Urinary albumin excretion rate was unaffected after 3 weeks' treatment by the diets: from (geometric mean ×/÷ tolerance factor) 32.4×/÷2.1 to 36.0×/÷1.9 g/min (NS) vs from 34.2×/÷1.9 to 32.1×/÷2.1 g/min (NS). Fasting plasma glucose, serum fructosamine and HbA_1c as well as lipid and lipoprotein concentrations were stable during both diets. Compared to the high-carbohydrate diet a reduction in the LDL/HDL cholesterol ratio was observed during the monounsaturated fat diet (p<0.03). In conclusion, compared to a high-carbohydrate diet, 3 weeks' treatment with a monounsaturated fat diet did not affect the levels of 24-h ambulatory blood pressure or albuminuria in microalbuminuric NIDDM patients. Moreover, glycaemic control and lipoprotein levels were unchanged, although a potential beneficial effect on the LDL/HDL-cholesterol ratio was noted. Monounsaturated fat represents an alternative in the diets of NIDDM patients especially when caloric intake is not a concern.Abbreviations UAE Urinary albumin excretion rate - NIDDM non-insulin-dependent diabetes mellitus - MUFA monounsaturated fatty acids - PUFA polyunsaturated fatty acids - ANOVA analysis of variance - CHO carbohydrate - CI confidence interval     

轻度妊高征患者动态血压变化与尿微量白蛋白排泄率的关系探讨

目的探讨轻度妊高征患者动态血压变化与尿微量白蛋白排泄率(UMAE)的关系。方法选择轻度妊高征患者(轻度妊高征组)68例和正常晚期妊娠的孕妇(正常妊娠组)76例,动态监测两组孕妇的24 h血压变化,同步监测UMAE变化情况,分析两者之间的相关性。结果轻度妊高征组孕妇24 h收缩压或舒张压平均血压、血压负荷均显著高于正常妊娠组孕妇(P均0.05);昼夜平均血压差低于正常妊娠组(P0.05);轻度妊高征组孕妇UMAE(50,6±32,4)mg/d,显著高于正常妊娠组(15.1±9.5)mg/d(P0.05);轻度妊高征患者24 h动态血压变化与UMAE呈正相关。结论轻度妊高征患者血压昼夜规律性变化消失,与其早期肾脏损害存在密切相关性;妊娠期间24 h监测动态血压与UMAE,有重要的临床指导意义。     

Blood pressure,retinopathy and urinary albumin excretion in IDDM: the EURODIAB IDDM Complications Study

Summary Several studies have shown an association between blood pressure and nephropathy, but few have been large enough to examine whether, or how, this relation is influenced by retinopathy. We have therefore examined the independent relations of blood pressure to urinary albumin excretion and retinopathy in a cross-sectional observational study of over 3000 insulin-dependent diabetic patients (the EURODIAB IDDM Complications Study). The relation of blood pressure to urinary albumin excretion differed strikingly between patients with (46%) and without (54%) retinopathy. In those with retinopathy, mean urinary albumin excretion rate was normal (<20 g/min) below median diastolic pressure (75 mm Hg) and increased steeply (p<0.001) with blood pressure above this level. However, in patients without retinopathy, mean albumin excretion rate was normal across the range of diastolic pressure. This finding could not be explained by differences in glycaemic control or duration of diabetes between patients with and without retinopathy. These data identify a subgroup of patients whose high risk of nephropathy may reflect abnormal renal vulnerability to mildly raised blood pressure. Retinopathy is a close correlate of this vulnerability. Detection of even mild retinopathy, together with raised blood pressure, may be important in assessing nephropathy risk.Abbreviations AER Urinary albumin excretion rate - IDDM insulin-dependent diabetes mellitus     

24-h ambulatory blood pressure and retinopathy in normoalbuminuric IDDM patients

Summary The role of blood pressure elevation in the incidence and progression of diabetic retinopathy is not clearly established and results have been conflicting. Blood pressure and urinary albumin excretion (UAE) are closely related. In order to evaluate the independent relationship between retinopathy and blood pressure elevation, precise information on UAE is essential, as confounding by renal disease (incipient or overt), cannot otherwise be excluded.The aim of the present study was to evaluate the association between diabetic retinopathy and 24-h ambulatory blood pressure (AMBP) in a group of well-characterized normoalbuminuric IDDM patients. In 65 normoalbuminuric (UAE < 20 μg/min) IDDM patients we performed 24-h AMBP (Spacelabs 90 207) with readings at 20-min intervals. Fundus photographs were graded independently by two experienced ophthalmologists. UAE was measured by RIA and expressed as geometric mean of three overnight collections made within 1 week. HbA_{1 c} was determined by HPLC. Tobacco use and level of physical activity were assessed by questionnaire. Fifteen patients had no detectable retinal changes [grade 1], 35 had grade 2 retinopathy; and 15 had more advanced retinopathy [grade 3–6]. Diastolic night blood pressure was significantly higher in patients with diabetic retinopathy compared to patients without retinopathy (68 ± 8 mmHg [grade 3–6] and 65 ± 6 mmHg [grade 2], compared to 61 ± 4 mmHg [grade 1], p = 0.02). Diurnal blood pressure variation was significantly blunted in the patients with retinopathy as indicated by a higher night/day ratio of diastolic blood pressure (84.6 % ± 4 [grade 3–6], and 81.2 % ± 6 [grade 2] compared to 79.1 % ± 4 [grade 1], p = 0.01). Heart rate tended to be higher in patients in group 2 and 3–6 compared to patients without retinopathy with p values of 0.07 and 0.11 for day-time and 24 h values, respectively. Mean HbA_{1 c} increased significantly with increasing levels of retinopathy (p < 0.01). Patients were similar regarding sex, age, tobacco use, and level of physical activity. Notably, UAE was almost identical in the three groups (5.0 × /÷1.7 [grade 1], 3.9 × /÷1.8 [grade 2], and 5.1 × /÷1.6 μg/min [grade 3–6]). In conclusion, night blood pressure is higher and circadian blood pressure variation blunted in patients with retinopathy compared to patients without retinopathy despite strict normoalbuminuria and similar UAE levels in the groups compared. Our data suggest that the association between blood pressure and diabetic retinopathy is present also when coexisting renal disease is excluded. Disturbed diurnal variation of blood pressure is a pathophysiological feature related to the development of both retinopathy and nephropathy in IDDM patients. [Diabetologia (1998) 41: 105–110] Received: 27 May 1997 and in revised form: 5 September 1997