早期糖尿病性腎症患者の運動と腎機能に関する研究

Abstract

The present study was designed to investigate the effect of exercise on renal function and urinary protein excretion in 20 non-insulin-dependent diabetic patients with microalbuminuria as compared with 15 healthy volunteers. Patients consisted of 11 males and 9 females with a mean age of 40 years. The exercise tests were performed on a treadmill of four different loads ; Ex1,4.7 METs for 10 minutes ; Ex2,4.7 METs for 20 minutes ; Ex3,7.0 METs for 10 minutes ; Ex4,7.0 METs for 20 minutes. Renal plasma flow (RPF) was measured by PAH clearance. Urinary excretion of albumin, β₂ microglobulin (β₂ MG) and N-acetyl-β-D-glucosaminidase (NAG) were measured before and after exercise, respectively. For hormonal function, plasma renin activity (PRA), plasma aldosterone concentration (PAC), plasma norepinephrine concentration (PNE) and human atrial natriuretic peptide (h-ANP) were also measured. In both controls and diabetic patients, RPF significantly decreased with each exercise (Ex1-2). GFR was unchanged during Ex1-2, but significantly decreased during Ex3-4. Urinary albumin excretion increased significantly in both groups during Ex2-4, but was unchanged only in the diabetic patients during Ex1. Urinary excretion of β₂ MG increased significantly in the diabetic patients with each exercise (Ex1-4), but no such increments were apparent in the controls. NAG was unchanged in both groups during Ex1-3, but was increased in the diabetic patients with Ex4. PRA and PAC significantly increased with each exercise (Ex1-4), but did not increase in the controls during Ex1-2. PNE increased significantly in both groups during Ex3-4. These findings suggest that exercise below the level of 4.7 METs is an allowable degree of daily activities in the management of patients with early-stage diabetic nephropathy.