Chieko Takahashi

Association between plasma oxidized low-density lipoprotein and diabetic nephropathy

To investigate the association of oxidized low-density lipoprotein (ox-LDL) with the development of diabetic nephropathy, plasma levels of ox-LDL were measured in 70 patients with type 2 diabetes mellitus. A sandwich enzyme-linked immunoadsorbent assay (ELISA) using the mouse monoclonal antibody FOH1a/DLH3, which specifically recognizes oxidized phosphatidylcholine, and a horseradish peroxidase (HRP)-labeled goat anti-human apolipoprotein B IgG was used to measure ox-LDL levels. The mean age of the patients was 57.0+/-1 3.4 years, and the mean duration of diabetes was 13.4+/-8.5 years. Plasma ox-LDL levels were similar in patients with normoalbuminuria (13.7+/-3.9 U/ml), patients with microalbuminuria (12.8+/-3.9 U/ml), and normal controls (12.5+/-4.2 U/ml). However, the plasma ox-LDL level in patients with macroalbuminuria (16.8+/-7.5 U/ml) was significantly higher than those in the other groups (P<0.05). Hemoglobin A1c (HbA1c) levels were similar in diabetic patients with normoalbuminuria (8.2+/-2.2%), microalbuminuria (7.8+/-1.3%), or macroalbuminuria (7.2+/-1.4%). There was no significant correlation between the ox-LDL level and the HbA1c level. The significantly elevated plasma ox-LDL levels in patients with macroalbuminuria suggest that ox-LDL may play an important role in the progression of diabetic nephropathy.

An IDDM patient who complained of chest oppression with ischemic changes on ECG in insulin-induced hypoglycemia

A 34-year-old female IDDM patient complained of chest oppression in hypoglycemic episodes and electrocardiograms revealed reversible ischemic changes occurring concomitantly with hypoglycemia. The ECG changes improved and the chest oppression disappeared following increasing blood glucose level by glucose intake. Masters double load test and treadmill load test were positive for ischemic changes. Radioisotopic myocardial scintigraphy by thallium and BMIPP did not show any filling defects and coronary angiography revealed no remarked stenosis in the coronary arteries. She had no mitochondrial tRNA(Leu) (A-->G) gene mutation at nucleotide position 3243, but both the patient and her mother had a G-to-A transition within the replication origin of the light strand at nucleotide position 5744 of the mitochondrial gene. As the patients maternal family had no history of ischemic heart disease, it is not clear whether mitochondrial gene mutation at nucleotide position 5744 reflects the occurrence of cardiac ischemia. Some disorders of microcirculation in capillary vessels in cardiac muscles may occur in such patients.

Clinical profile of Japanese dialysis patients with diabetic nephropathy, diagnosed as having diabetes before the age of thirty

Diabetic nephropathy is the leading cause of death in young diabetic patients. There are a large number of patients with non-insulin-dependent diabetes mellitus (NIDDM) who are diagnosed before the age of 30 in Japan. We investigated 36 patients with young-onset diabetes who started dialysis between 1978 and 1987 in our hospital. Of the 36 patients, 12 (33.3%) were classified as having insulin-dependent diabetes mellitus (IDDM), 22 (61.1%) had NIDDM, and 2 (5.6%) could not be classified clinically. The percentages of the different types of diabetes in our series of dialysis patients were almost identical with those in Nagais series of 551 diabetic patients diagnosed before the age of 30 at the Diabetes Center of Tokyo Womens Medical College from 1976 to 1981. The present study showed the young-onset NIDDM in Japan was associated with almost the same incidence of end-stage diabetic nephropathy as was IDDM. However, the number of NIDDM patients diagnosed under 30 years of age was almost double that of IDDM patients. Thus, we have to pay greater attention to the development of diabetic nephropathy in young-onset NIDDM patients than has been thought necessary in the past.

Analysis of the clinical course of 130 Japanese non-insulin-dependent diabetic patients undergoing dialysis.

To clarify the characteristics of diabetic nephropathy (DN) in Japanese patients with non-insulin-dependent diabetes (NIDDM), we analyzed the clinical course of 130 such patients who began dialysis treatment due to DN between 1978 and 1988 at the Diabetes Center of Tokyo Womens Medical College. Analysis of the clinical course prior to attending the Diabetes Center revealed that 64 (49.2%) of the patients neglected or discontinued their initial treatment for diabetes until the development of diabetic complications because of the lack of symptoms. The average duration of untreated diabetes in these patients was 10.7 +/- 4.6 years. The biggest problem for NIDDM patients was the absence of symptoms until the development of diabetic complications.

Long-term Prognosis of end-stage renal failure at a single institution.

目的: 患者移動が少ない1施設において, 透析患者の導入後の長期予後と, 予後に及ぼす因子につき, 検討した.対象と方法: 対象は, 昭和46年より横浜平和病院で血液透析を導入し, 経過を観察できた142名 (男82名, 女60名) である.予後因子に1) 導入時溢水の有無, 2) 原腎疾患としての糖尿病性腎症の有無, 3) 導入時年齢, 4) 性, 5) 導入時期 (-S 57, S 58-) をとりあげた. 解析は, 累積生存率を生命表法分析により行い, 相対死亡危険度を比例ハザードモデルにより求めた.結果: 透析導入患者は, 過去20年間で約25歳の高齢化を認め, 糖尿病の増加が顕著であった.導入後の予後は, 単変量解析では高齢者, 溢水導入, 糖尿病, 男性, 近年導入 (昭和58年以降) 例で不良であった. Cox比例ハザードモデルによる予後因子の分析では高齢, 溢水導入が有意であり, 糖尿病, 性差, 導入時期は有意でなかった. 最終観察 (平成2年12月31日) までに, 死亡例は71名で心血管系疾患によるものが31例 (44%) であった.