Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria

Summary In insulin-dependent diabetes mellitus (IDDM), microalbuminuria predicts renal and cardiovascular disease. We report a combined analysis of 235 normotensive IDDM patients with microalbuminuria who participated in two 24-month double-blind, randomised, placebo-controlled trials to assess the effects of captopril 50 mg twice daily on the progression to overt clinical albuminuria. Of the 225 patients who were evaluable on an intent to treat basis, 25 of 114 placebo-treated patients (21.9%) and 8 of 111 captopril-treated patients (7.2%) progressed to persistent clinical albuminuria. The risk of progression over 24 months was significantly reduced by captopril (p=0.004) with a risk reduction of 69.2% (95% confidence interval (CI): 31.7 to 86.1%). This degree of risk reduction remained at the same level (62.9% [16.1–83.6%], p=0.017) after adjustment for differences in time-varying mean arterial blood pressure. Albumin excretion rate increased by an average of 14.2% [3.1–26.5%] per year in the placebo-treated group compared with a reduction of 9.6% [–18.6–0.4%] per year in the captopril-treated group (p=0.002). The rate of fall of creatinine clearance tended to be faster in the placebo-treated group than in the captopril-treated group (–6.4 [–10.2––2.5] vs –1.4 [–5.3–2.6] ml · min^–1 · 1.73 m^–2, p=0.07). Baseline albumin excretion rate (p<0.0001) and glycated haemoglobin (p=0.03) were independent predictors of progression to clinical albuminuria and changes in mean arterial blood pressure (p=0.02) and serum cholesterol level (p=0.003) were significantly associated with percentage changes in albumin excretion rate. Captopril reduces the risk of progression to overt nephropathy in IDDM patients with microalbuminuria, an effect partly independent of its blood pressure-lowering effects.Abbreviations ACE Angiotensin converting enzyme - IDDM insulin-dependent diabetes mellitus - GFR glomerular filtration rate - C captopril - P placebo - AER albumin excretion rate - MAP mean arterial pressure Corresponding author: Professor G.C. Viberti, Unit for Metabolic Medicine, United Medical and Dental Schools of Guy's and St. Thomas' Hospitals, Guy's Hospital, London SE1 9RT, UKMembership of the Study Group is listed in the Acknowledgement section     

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     

Prevalence of diabetic retinopathy in children and adolescents with IDDM A population-based multicentre study

Summary Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6 %) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4–17.0]) years and with a diabetes duration of 8.0 (5.5–9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5 %):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6 % and 18 % of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years. [Diabetologia (1997) 40: 307–310] Received: 18 January 1996 and in revised form: 14 November 1996     

Islet transplantation in IDDM patients

Summary This single-centre study investigated parameters that positively correlated with the success rate after islet allotransplantation in insulin-dependent diabetic (IDDM) patients. Twenty-one intrahepatic, fresh islet transplantations were performed in 20 IDDM patients (one patient had two transplants), after or simultaneous with kidney transplantation. The correlation between number and purity of transplanted islets and final outcome was investigated. One patient died of a cardiac arrest several hours after islet transplantation; this patient was not included in the follow-up analysis. Three patients (15 %) experienced acute, irreversible, early failure of islet function, which was considered as a ’presumed rejection'. Nine patients (45 %) achieved either complete insulin-independence (seven cases) or a reduction (> 50 %) of exogenous insulin requirement (two cases), with sustained serum C-peptide secretion (0.89 ± 0.04 nmol/l; duration: 21 ± 7 months, range 2–58 months). Liver biopsy, performed 3 years after transplantation in one successful case, showed normal islets within the hepatic parenchyma. Eight cases (40 %) did not show any metabolic effect of islet transplantation, with low serum C-peptide levels (’presumed function exhaustion'). Metabolic investigations performed in successful cases showed an early phase of insulin release after arginine, mild and reversible postprandial hyperglycaemia and normal HbA_1c levels. Success of islet transplantation positively correlates with the number (p < 0.05) of the transplanted islets. Islet transplantation is a safe procedure, with 45 % success rate, in terms of insulin-independence or relevant reduction of exogenous insulin requirement, although success can be transient. [Diabetologia (1997) 40: 225–231] Received: 20 June 1996 and in final revised form: 28 October 1996     

Long-term risk of IDDM in first-degree relatives of patients with IDDM

Summary Due to a short observation period previous studies may have underestimated prevalence and recurrence risk of IDDM in relatives of IDDM patients. To obtain a more exact life-time risk estimate we identified 310 probands, representative of Danish IDDM patients, characterized by current age more than 50 years, age at onset 40 years or less and diabetes duration of more than 30 years. Family data were obtained from 291 probands. Mean observation times (age) (± SD) for siblings (n = 553) and offspring (n=359) were 59.4 ± 16.1 years and 33.8 ± 8.8 years, respectively. Of the probands 73 (25.1%) had at least one first-degree relative with IDDM. Seventeen percent had at least one affected sibling. An increase from 10.4% to 22.4% of having first-degree relatives with IDDM among probands with age at onset below 20 years was observed during the period from proband at age 21 years up to 1 September 1992. Among affected siblings 48% of the second cases were affected more than 10 years after the first affected sibling. Using the life-table method cumulative recurrence risks from time of birth were calculated for siblings up to age 30 years of 6.4% and up to age 60 years of 9.6%. For offspring the risk up to age 34 years was 6.3%. In addition, we present a life-table method evaluating the cumulative recurrence risk from time of onset in the proband, as this is the most relevant when giving genetic counselling. In conclusion, the long-term risks of IDDM in siblings and offspring are high compared to that shown in previous reports.Abbreviations IDDM insulin-dependent diabetes mellitus - SE standard error     

氯沙坦对伴有微量蛋白尿的老年高血压患者的影响

目的　观察氯沙坦对伴有微量蛋白尿（ ＭＣＡ） 的老年高血压患者改善肾损害的作用。　方法　采用连续样本,自身前后及分组对照方法,对３２ 例高血压伴ＭＣＡ 者（ＥＨ 组） ,男２４ 例,女８ 例,平均年龄（７１－６ ±６－８）岁,观察在治疗前和每天服用氯沙坦５０ ｍ ｇ １２ 周后的血压、血尿素氮（ＢＵＮ） 、血肌酐（Ｃｒ） 、２４ｈ 内生肌酐清除率（Ｃｃｒ） 、尿白蛋白／ 肌酐（Ａｌｂ／Ｃｒ） 的变化,ＥＨ 组治疗前在ＢＵＮ、Ｃｒ 、Ｃｃｒ 方面与１２ 例非高血压老人作对照（ 对照组） 。　结果　治疗前ＥＨ 组的Ｃｃｒ 水平较对照组明显降低（ Ｐ＜ ０－０５） ,用氯沙坦治疗后,除血压有明显下降外,尿Ａｌｂ／Ｃｒ 亦显著性降低（ Ｐ＜ ０－０１） ,Ｃｃｒ 明显升高（ Ｐ＜ ０－０５） 。　结论　氯沙坦对老年高血压患者不仅有良好的降压效果,同时可降低尿白蛋白的排泄,改善肾功能     

Nocturnal hypoglycaemia in IDDM patients younger than 18 years

The present multicentre study was undertaken to assess the prevalence of nocturnal hypoglycaemia and its determining factors in 117 diabetic children and adolescents, aged 2–18 years and diabetes duration >1 year in Spain. Each child made 3 measurements of blood glucose (BG) at home at night (between 0000 h and 0600 h) on nine separate nights. A hypoglycaemic event occurred in 12–14 % of children in any one night. This is lower than rates for nocturnal hypoglycaemia reported in literature, perhaps because of relatively late mealtimes and different meal content, in Spanish children. Children aged <7 years were at higher risk of nocturnal hypoglycaemia than older children (p < 0.05). Mean HBA_1c from the year before the study and mean HbA_1c measured during the closest time to the study were significantly lower in those with nocturnal hypoglycaemia (p < 0.0001). Blood glucose concentrations 2 h before hypoglycaemia did not predict nocturnal hypoglycaemia. The occurrence of low or very low blood glucose concentrations before breakfast was related to a higher risk for nocturnal hypoglycaemia (χ² 22.97; p < 0.001). No previous symptoms were detectable in 89 % of cases. © 1997 John Wiley & Sons, Ltd.     

Microvascular and acute complications in IDDM patients: the EURODIAB IDDM Complications Study

Summary The prevalence of microvascular and acute diabetic complications, and their relation to duration of diabetes and glycaemic control were examined in a cross-sectional study of 3250 IDDM patients in Europe (EURODIAB IDDM Complications Study). Mean (SD) duration of diabetes was 14.7 (9.3) years. HbA_1c and AER were measured centrally. Retinopathy was assessed by centrally graded retinal photography. Autonomic neuropathy was measured by heart rate and blood pressure responses to standing up. Sensory neuropathy was measured by biothesiometry. Normal HbA_1c was found in 16% of patients. An AER of 20 g/min or higher was found in 30.6% (95% CI 29.0%, 32.2%) of all patients, and 19.3% (15.6%, 23.0%) of those with diabetes for 1 to 5 years. The prevalence of retinopathy (46% in all patients; 82% after 20 or more years) was substantially lower than in comparable studies. Of all patients 5.9% (5.1%, 6.7%) had postural hypotension, 19.3% (17.9%, 20.7%) had abnormal heart rate variability, 32.2% (30.6%, 33.8%) reported one or more severe hypoglycaemic attacks during the last 12 months and 8.6% (7.6%, 9.6%) reported hospital admission for ketosis over the same period. Microvascular and acute complications were clearly related to duration of diabetes and to glycaemic control. However, the relation of glycaemic control to raised albuminuria differed qualitatively from its relation to retinopathy.Abbreviations IDDM Insulin-dependent diabetes mellitus - VPT vibration perception threshold - AER rate of urinary albumin excretion - CI confidence interval     

高血压患者踝臂指数与尿微量白蛋白的相关性

目的 探讨高血压患者踝臂指数（ABI）与尿微量白蛋白（MAU）的关系.方法 80例原发高血压患者经连续2次检查晨尿排除显性蛋白尿,采用多普勒超声法检测四肢动脉血压,计算ABI,分为ABI正常组（38例）和ABI减低组（42例）,连续2次检查晨尿常规及MAU.结果 两组MAU阳性率分别为28.9%（11/38）和54.8%（23/42）,MAU分别为（21±11）mg/L和（38±24）mg/L,差异均有统计学意义（P＜0.05）.直线相关性分析显示,ABI正常组ABI与MAU无显著相关（r＝0.18,P＞0.05）,而ABI减低组ABI与MAU呈显著负相关（r＝-0.63,P＜0.01）.结论 ABI减低的高血压患者MAU增加,提示ABI减低对评估高血压患者早期肾功能损害有参考价值.     

病程10年以上的IDDM微血管并发症分析

１６３例病程超过１０年的胰岛素依赖型糖尿病，２３．９％合并增殖性视网膜病变，１１．７％合并临床肾病。严重的微血管并发症的发生与发展和糖尿病病程、病情控制程度及是否中断随访治疗密切相关。起病后第一个１０年，在本院糖尿病门诊连续跟踪治疗，使血糖长期稳定控制在Ⅰ级，有效地减少了微血管并发症的发生。     

Efficacy of ACE inhibitors and ATII receptor blockers in patients with microalbuminuria: a prospective study

We compared the efficacy of treatment protocols with an angiotensin converting enzyme (ACE) inhibitor alone (enalapril, 5 mg) or angiotensin II (ATII) receptor blocker (losartan, 50 mg) or both enalapril plus losartan in patients with microalbuminuria in a prospective, randomized clinical trial. Normotensive type 2 diabetic patients with microalbuminuria documented by at least 3 consecutive urinary albumin excretion analyses were recruited for the study. Patients were grouped randomly into one of the protocols which consisted of treatment with 5 mg enalapril daily (group 1; n=12), 50 losartan daily (group 2; n=12) or both drugs (group 3; n=10). They were reevaluated with regard to HbA1c levels, lipid profiles, blood pressure and urinary albumin excretion rates (UAER) at 3-month intervals for 12 months. Mean age, duration of diabetes, body mass index, plasma lipid profiles and blood pressure levels were similar at the initial visit. In group 1, UAER returned to normal levels in 10 patients. Normalization of UAER occurred in 8 and 7 patients in groups 2 and 3, respectively. Percentage of reduction in UAERs at the end of 12 months were 58%, 59% and 60% (p=0.0001; p=0.0002; p=0.0003, respectively). The amount of reduction in UAER did not differ significantly among the three groups (p=0.346). ACE inhibitors and angiotensin II receptor blockers have similar efficacy in treating diabetic microalbuminuria, and the combination of the two drugs does not add any further benefit. Received: October 2000 / Accepted in revised form: 27 September 2001     

Elevated serum angiotensin I converting enzyme activity in type I,insulin-dependent diabetic subjects with persistent microalbuminuria

Angiotensin I-converting enzyme (ACE), which is synthesized by vascular endothelial cells, is sometimes elevated in diabetic subjects. To determine whether serum ACE is elevated in subjects at high risk of malignant microangiopathy, serum ACE activity in 34 normotensive, type 1 insulin-dependent diabetic subjects with persistent microalbuminuria (30–300 mg/24 h) was compared with that in 30 normotensive, normoalbuminuric type 1 diabetic subjects of the same age [37±15 (mean ±SD) vs 38±14 years], sex (21 M/13 F vs 15 M/15 F), stage of retinopathy (14 vs 16 nil/11 vs 7 background/6 vs 4 preproliferative/3 vs 3 proliferative) and HbA_1c (7.7±1.9 vs 8.2±1.0%). Serum ACE activity of diabetic subjects was also compared with 120 age and sex related healthy controls. Serum ACE activity was higher in subjects with microalbuminuria than in those with normoalbuminuria (406±114 vs 359±97 IU/l;P=0.03), or in controls (307±95 IU/l;P=0.0001). Normoalbuminuric subjects also had higher ACE activity than controls (P=0.02). Serum ACE activity was not related to diabetes duration (r=0.01; NS), HbA_1c (r=0.05; NS), or stage of retinopathy in diabetic subjects (r=0.06; NS), while stage of retinopathy was related to age (r=0.42;P=0.003) and to diabetes duration (r=0.74;P=0.0001) in these subjects. Elevated ACE activity occurs in type 1 diabetic subjects, especially in those with microalbuminuria. This may give early indication of lesions in vascular endothelial cells.This work was presented at the 27th meeting of the European Association for the Study of Diabetes in Dublin, Ireland, 10–14 September 1991, and published in an abstract form: Diabetologia (1991) 34: A17     

依那普利对糖尿病者肾血流动力学及尿白蛋白的影响

本文比较了２８例老年糖尿病合并微白蛋白尿患者服依那普利（ｅｎａｌｐｒｉｌ）４周前后尿微量白蛋白、血及尿β２－微球蛋白、肾小球滤过率（以内生肌酐清除率表示）等变化。结果显示服药后尿微白蛋白排泄减少、内生肌酐清除率下降；将２８例分成正常（尿白蛋白＜２５ｍｇ／２４ｈ）及亚临床微白蛋白尿组（２５～１００ｍｇ／２４ｈ），发现前组服药后尿白蛋白排泄率无变化，而后组明显减少；按内生肌酐清除率将２８例分成正常组（＜１２０ｍｌ／ｍｉｎ）和升高组（＞１２０ｍｌ／ｍｉｎ），发现前组服药后内生肌酐清除率无改变，而后组明显降低。因此依那普利对老年糖尿病伴有尿微白蛋白和（或）内生肌酐清除率升高患者的肾脏有更明显的保护作用。     

Comparison of methods for determination of microalbuminuria in diabetic patients

Microalbuminuria is an early marker of prognostic significance in diabetic renal disease. The aim of the present study was to compare methods which do not require radioactive markers for estimating microalbuminuria (20-300 mg l-1) with a radioimmunoassay for albumin estimation. Albumin concentrations of 329 diabetic patients were measured using two laser turbidimetric methods for albuminuria and proteinuria, two semiquantitative tests (Albusure and Albustix), and a routine albumin radioimmunoassay. The four methods in the order laser immunoturbidimetric for albuminuria, laser turbidimetric for proteinuria, Albusure and Albustix gave the following results: sensitivity 0.97, 0.93, 0.97 and 0.81; specificity 0.92, 0.88, 0.94 and 0.55; positive predictive value for microalbuminuria 0.83, 0.75, 0.85 and 0.42; negative predictive value for microalbuminuria 0.99, 0.97, 0.99 and 0.88. We suggest that both laser turbidimetric methods are reliable and can replace methods with radioactive markers, the same being true for the Albusure test.     

氯沙坦与培多普利对高血压患者微量蛋白尿排泄的影响

目的：比较血管紧张素受体拮抗剂Ⅱ（AⅡA）氯沙坦与血管紧张素转换酶抑制剂（A－CEI）培多普利对高血压患者微量蛋白尿排泄的影响。方法：选择60例原发性高血压患者，随机分为氯沙坦组（n=30)和培多普利组（n=30)，分别予以氯沙坦50mg每日一次及培多普利4mg每日一次，治疗4周，治疗前后分别测血压及尿微量蛋白值，并进行比较。结果：两组患者经4周治疗，血压降至正常，微量蛋白尿排泄明显减少（P＜0．01），且氯沙坦组疗效优于培多普利组（P＜0．05）。结论：AⅡA及ACEI可有效减少高血压患者微量蛋白尿排泄，而AⅡA效果优于ACEI。     

周围血单个核细胞抑制胰岛素释放的实验研究

将新发病的ＩＤＤＭ病人周围血单个核细胞（ＰＢＭＣ）同大鼠胰岛共同培养２０个小时后用Ｌ－精氨酸刺激，收集并测定基础和刺激后培养上清中胰岛素的含量，结果显示：ＩＤＤＭ病人ＰＢＭＣ作用下的基础胰岛素释放（１１７．９±１４．０±μＵ·１０ｉｓｌｅｔｓ－１／２０ｈ）（ｎ＝１１）和刺激后胰岛素释放（１４７．５±３２．３μＵ·１０ｉｓｌｅｔｓ－１／３ｈ）（ｎ＝１１），显著低于正常人ＰＢＭＣ作用下的基础胰岛素释放（１８４．８±２９．５μＵ）（ｎ＝１０，Ｐ＜０．０１）和刺激后胰岛素释放（１９５．０±２７．４μＵ）（ｎ＝１０，Ｐ＜０．０１）。结果表明新发病的ＩＤＤＭ病人ＰＢＭＣ能够抑制大鼠胰岛基础和刺激后胰岛素的释放。     

糖尿病心率变异性分析与微量白蛋白尿的关系

目的 探讨糖尿病患者微白蛋白尿与心脏自主神经病变之间的关系。方法 应用２４小时动态心率变异性（ＨＲＶ）频率分析技术,对４６例糖尿病患者及３１例正常对照者测定了ＨＲＶ,并与尿白蛋白排泄率作相关分析。结果 糖尿病患者在不同尿白蛋白排泄（ＵＡＥ）阶段,心率变异性时域分析各项指标参数均为降低,其中伴微白蛋白尿组（ＤＭＢ）较正常蛋白尿组（ＤＭＡ）ＨＲＶ各项参数降低更明显,有极显著性差异（Ｐ〈０．０１）。糖尿     

Predictors of IDDM recurrence risk in offspring of Danish IDDM patients

Summary It has previously been observed that offspring of mothers with insulin-dependent diabetes mellitus (IDDM) have a lower risk of IDDM than offspring of IDDM affected fathers. To assess the offspring IDDM recurrence risk in a Danish population-based study and to investigate parental and offspring-related biological variables that might influence this risk, we identified 2726 IDDM probands and their 2826 offspring from a background population of 1.725 million people (33 % of the Danish population). Current age of probands was 20–65 years and their age at IDDM onset was 30 years or less. Sixty-nine offspring (2.4 %) were affected with IDDM. The sex difference in the parental-offspring IDDM transmission rate was confirmed. The cumulative IDDM risk up to age 30 years was found to be significantly decreased in maternal offspring compared to paternal offspring (2.3 ± 0.6 and 5.7 ± 0.9 %, RR = 2.40, 95 % CI 1.30–4.47; p = 0.004) only if parents were diagnosed with IDDM before birth of the offspring. However, due to the low number of diabetic offspring of probands diagnosed with IDDM after offspring birth, this observation needs to be confirmed in a larger population. In a subpopulation of the 2380 offspring, whose parents were all diagnosed with IDDM before offspring birth, the recurrence risk was significantly increased in offspring of male probands diagnosed up to age 17 years compared to offspring of fathers diagnosed at older ages (8.5 ± 1.8 and 3.6 ± 1.0 %; RR = 2.27, 95 % CI 1.21–4.25; p = 0.006). No such relation was found in maternal offspring. Using the Cox proportional hazards model on this offspring subpopulation we found that paternal age at IDDM onset was the only statistically significant predictor of IDDM recurrence risk. Our findings may be important for counselling families in which one parent has IDDM. [Diabetologia (1998) 41: 666–673] Received: 14 July 1997 and in revised form: 29 December 1997     

高血压糖尿病患者尿微量白蛋白与动脉弹性之间的关系

目的了解高血压和糖尿病患者尿微量白蛋白与动脉弹性改变之间的关系.方法对入选的200例高血压和（或）糖尿病患者进行晨尿白蛋白/肌酐比值测定,根据结果将入选患者分为尿白蛋白/肌酐比值正常和升高两组.分别应用DO-2020动脉功能测定仪、Complior自动脉搏波速度测定仪测定动脉弹性相关指标：大动脉弹性指数（C1）、小动脉弹性指数（C2）、颈-股动脉脉搏波传导速度（PWVcf）.应用统计学方法进行C1、C2、PWVcf组间差异比较.结果（1）尿白蛋白/肌酐比值升高组C1、C2均明显低于正常组,PWVcf显著高于正常组,差异有统计学意义（P〈0.01）.（2）年龄分层后发现,〈60岁组患者中,尿白蛋白/肌酐比值升高组C1显著低于正常组,PWVcf显著高于正常组,差异有统计学意义（P〈0.01）;≥60岁组中,尿白蛋白/肌酐比值升高组C1、C2明显低于正常组,差异有统计学意义（P〈0.05）.（3）将患者分为单纯高血压、单纯糖尿病、高血压合并糖尿病3组进行分析,结果显示：3组患者中尿白蛋白/肌酐升高组C1、C2均低于正常组,PWVcf均高于正常组,高血压合并糖尿病组差异有统计学意义（P〈0.05）.结论高血压和糖尿病患者尿白蛋白/肌酐比值的升高与其动脉功能有关,尿白蛋白排泄率高的患者存在明显的动脉弹性功能异常.