据《美国肾脏病学会杂志》2007年1月期的一项随机研究报道，中心型肥胖是1型糖尿病出现尿微量白蛋白尿的独立危险因素。
“体重增加和中心型肥胖与1型糖尿病的胰岛素抵抗、高血压以及血脂障碍相关。”西雅图华盛顿大学的Ian H. de Boer, MD和来自糖尿病控制和并发症研究小组、糖尿病干预流行病学和并发症研究团队的同事得出上述结果。“上述代谢异常是普通人群的肾脏疾病的危险因素，但是在1型糖尿病病人中关于中心型肥胖和肾脏疾病的相关性的数据很少。”
为了确认腰围和尿微量白蛋白、肌酐清除率之间的相关性，研究人员评估了1279名1型糖尿病的入选者，他们来自于糖尿病干预流行病学和并发症研究的入围者，同时是糖尿病控制和并发症临床研究小组（DCCT）的延伸观察。
在5.8年的随访研究中，1105名在DCCT研究结束时白蛋白排泄率（AER）正常的参与者中，有93名发生了偶见的微量白蛋白尿。在调整了DCCT结束时的年龄、性别、糖尿病病程、治疗方案，烟草摄入、糖化血红蛋白和AER因素后，偶见的微量白蛋白尿和DCCT结束时腰围每10cm的增加量的危害性相关指数为1.34.（95%可信区间为1.07-1.68）。
在进一步调整血压和血脂分层后，这个高危因素有轻度的减弱。在随后的8年里每年每1.73m2的肌酐清除率平均下降了0.34ml/分。更快的肌酐清除率下降速度和年龄增长， DCCT中的常规胰岛素治疗，吸烟、更高的糖化血红蛋白水平、DCCT结束时的AER有关，但是和腰围无关。
该研究的局限性包括不能排除随访8年中心型肥胖在肾小球滤过率延迟方面的作用，缺乏体内脂肪分布的放射性量化指标，肌酐清除率的测定方法不够优化，缺乏从一项临床研究的受试者向更多1型糖尿病人群的推广化研究。
“1型糖尿病病人中的腰围可以预示微量白蛋白尿的继发性发生，”作者说，“相反，时间证明腰围和肌酐清除率之间无相关性，进一步提示在这一人群中微量白蛋白尿和肾脏的排泄功能受损之间在病理机制和危险因素上都有不同。
这项研究受国立卫生研究院和内分泌学会基金组赞助。作者已证实无相关经济关系。
Central Obesity Increases Risk for Microalbuminuria in Type 1 Diabetes
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
December 11, 2006 — Central obesity is an independent risk factor for incident microalbuminuria in individuals with type 1 diabetes, according to the results of a randomized study reported in the January 2007 issue of the Journal of the American Society of Nephrology.
"Weight gain and central obesity are associated with insulin resistance, hypertension, and dyslipidemia in type 1 diabetes," write Ian H. de Boer, MD, of the University of Washington in Seattle, and colleagues from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. "These metabolic abnormalities are risk factors for kidney disease in the general population, but data addressing the relationship of central obesity with kidney disease in type 1 diabetes are limited."
To determine whether waist circumference is associated with incident microalbuminuria and change in creatinine clearance, the investigators evaluated 1279 participants with type 1 diabetes who were enrolled in the Epidemiology of Diabetes Interventions and Complications Study, the observational extension of the Diabetes Control and Complications Trial (DCCT).
During 5.8 years of follow-up, 93 of 1105 participants with normal albumin excretion rate (AER) at DCCT closeout developed incident microalbuminuria. After adjustment for DCCT closeout age, sex, duration of diabetes, treatment group, smoking status, glycated hemoglobin (HbA1c), and AER, the hazard ratio (HR) for incident microalbuminuria that was associated with each 10-cm greater waist circumference at DCCT closeout was 1.34 (95% confidence interval [CI], 1.07 - 1.68).
After additional adjustment for levels of blood pressure and serum lipids, this increased risk was modestly attenuated. Creatinine clearance decreased by an average of 0.34 mL/minute per 1.73 m2 per year during 8 years of follow-up. Faster rate of decrease in creatinine clearance was associated with increased age, conventional insulin therapy during the DCCT, smoking, and greater HbA1c level and AER at DCCT closeout, but not with waist circumference.
Study limitations include inability to exclude an effect of central obesity on glomerular filtration rate delayed beyond 8 years of follow-up, lack of radiographic quantification of body fat distribution, less than optimal measurement method for creatinine clearance, and lack of generalizability from a clinical trial setting to the broader population with type 1 diabetes.
"Waist circumference predicts the subsequent development of microalbuminuria in type 1 diabetes," the authors write. "In contrast, no association was observed between waist circumference and change in creatinine clearance over time, further suggesting that microalbuminuria and loss of excretory kidney function may have different risk factors and pathogenic mechanisms in this population."
The National Institutes of Health and the Endocrine Fellows Foundation supported this study. The authors have disclosed no relevant financial relationship.
J Am Soc Nephrol. 2007;18:235-243.
http://www.medscape.com/viewarticle/549105
编辑：蓝色幻想
