MORBIDITY, MORTALITY, AND ALBUMINURIA IN TYPE-2 DIABETIC-PATIENTS - A 3 YEAR PROSPECTIVE-STUDY OF A RANDOM COHORT IN GENERAL-PRACTICE

被引:68
作者
STIEGLER, H
STANDL, E
SCHULZ, K
ROTH, R
LEHMACHER, W
机构
[1] Third Medical Department and Diabetes Research Unit, City Hospital Schwabing, Munich
[2] Institute for Medical Informatics and System Research Medis, Neuherberg
关键词
MICROALBUMINURIA; PROTEINURIA; TYPE-2; DIABETES; MORTALITY; MACROVASCULAR MORBIDITY; PERIPHERAL VASCULAR DISEASE;
D O I
10.1111/j.1464-5491.1992.tb01861.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In a 3-year prospective study, the prevalence of albuminuria and its relationship to macrovascular disease, pre-existing vascular risk factors and mortality rate were studied in a random cohort of 290 patients with Type 2 diabetes mellitus in general practice. Newly occurring micro- or macroalbuminuria was associated with significantly (p<0.05) higher systolic blood pressure: median (IQ range) 157 (140-170) vs 150 (130-160) mmHg, in addition to higher serum triglycerides: median (IQ range) 2.71 (1.84-4.25) vs 1.84 (1.35-3.14) mmol l-1, and C-peptide levels: median (IQ range) 1.30 (0.98-2.16) vs 1.10 (0.82-1.58) nmol l-1, at 3-year follow-up. Patients with macroalbuminuria at final examination had significantly higher systolic and diastolic blood pressure, serum triglyceride and beta-2-microglobulin levels, decreased HDL-cholesterol, and a significantly higher prevalence of carotid artery stenoses and peripheral vascular disease. Patients dying from vascular causes showed significantly higher urinary albumin levels at entrance as compared to the surviving patients: median (IQ range): 42.2 (11-249.7) vs 10.4 (4.6-28.0) mg l-1, p<0.008, and overall mortality rate was significantly linked with the presence of macroalbuminuria (26 % vs 5 % in normoalbuminuric patients). A comparison between the results of the initial and the final examination indicated an overall worsening of renal variables (albuminuria: median (IQ range): female 9.5 (4.5-21) vs 13.4 (5.1-39.7) mg l-1, (p<0.05); male 13.8 (4.7-34.1) vs 32.6 (8.1-78.7) (p<0.001), despite a significant improvement in metabolic variables. At the same time, a significant increase of the prevalence of peripheral vascular disease (female 41 vs 59 %, p<0.005; male 35 vs 47 %, p<0.05; 95 % confidence interval: female 33-49 % vs 51-67 %; male 25-46 % vs 36-58 %) and stenoses of the carotid artery (female 8.6 vs 18 %, p<0.05 and male 4.8 vs 16 %, p<0.005, 95 % CI: female 4.8-14 % vs 12.4-24.8 %, male 1.3-11.9 vs 8.8-25.9) was found. Macroalbuminuria in particular appears to be a marker of peripheral vascular disease accompanied by a number of risk factors commonly seen in the context of Syndrome X, and predicts macrovascular deaths.
引用
收藏
页码:646 / 653
页数:8
相关论文
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