尿微量白蛋白/肌酐比值对糖尿病肾病早期诊断价值

目的 探讨尿微量白蛋白/肌酐比值在糖尿病肾病早期诊断中的价值.方法 选取确诊为2型糖尿病患者293例和体检健康体检者70例,对其尿微量白蛋白/肌酐比值（晨起空腹及随机）、24小时尿微量白蛋白定量、尿微量白蛋白排泄率、尿素氮、血肌酐、尿常规等临床资料进行回顾性分析,观察上述不同检测方法对糖尿病早期诊断灵敏度.结果 晨起、随机尿微量白蛋白/肌酐值与尿微量白蛋白排泄率（urine albumin excretion rateUAER）、24 h尿微量白蛋白定量成显著正相关,晨起空腹尿ACR与UAER、24小时尿微量白蛋白定量的相关系数分别为r＝0.936（P＜0 01）,r＝0.906,（P＜0.01）;随机尿ACR与UAER和24h尿微量白蛋白相关系数分别为r＝0.756（P＜0.01）,r＝0.738,（P＜0.01）.2型糖尿病组尿ACR阳性组和阴性组之间比较尿蛋白、血肌酐、尿素氮水平无统计学差异,P＞0.05.将血肌酐、尿素氮、尿ACR诊断糖尿病肾病敏感性比较,尿ACR阳性率显著高于前两者,P＜0.01.结论 晨起空腹及随机尿微量白蛋白/肌酐比值两者均可以作为糖尿病肾病早期诊断的敏感指标.     

2型糖尿病患者微量白蛋白尿临界值的研究

目的研究2型糖尿病(T2DM)患者晨尿、随机尿的尿白蛋白/肌酐比值(ACR)及尿白蛋白(U-Alb)浓度,判定微量白蛋白尿的临界值,以检测早期糖尿病肾脏疾病(DKD)。方法收集169例T2DM患者及40名健康体检者(正常对照组)的24 h尿、晨尿、随机尿,以24 h尿白蛋白排泄率(UAE)为早期DKD的判定标准,分析目前临床应用的晨尿、随机尿的ACR及U-Alb浓度判定微量白蛋白尿的临界值对早期DKD的筛查效能;根据受试者工作特征(ROC)曲线分析,Youden指数最大时对应的晨尿、随机尿的ACR及U-Alb浓度为检测早期DKD微量白蛋白尿的临界值。结果在微量白蛋白尿判定结果中,晨尿ACR与24 h UAE的符合率为43%,UAlb为37%;随机尿ACR为48%,U-Alb为41%,以上4个指标与24 h UAE的判定结果有明显差异(P均0.001)。正常对照组晨尿、随机尿检测结果判定与24 h UAE一致,均为正常。ROC曲线分析显示ACR晨尿临界值为男16 mg/g、女23 mg/g(Youden指数分别为0.70、0.67,阴性预测值分别为97%、100%,阳性预测值分别为72%、65%);ACR随机尿临界值为男17 mg/g、女28 mg/g(Youden指数分别为0.68、0.67,阴性预测值分别为90%、90%,阳性预测值分别为61%、82%);U-Alb晨尿临界值为男16 mg/L、女15 mg/L(Youden指数分别为0.57、0.59,阴性预测值分别为84%、87%,阳性预测值分别为90%、73%);U-Alb随机尿临界值为男17 mg/L、女14 mg/L(Youden指数分别为0.56、0.53,阴性预测值分别为73%、81%,阳性预测值分别为85%、71%)。ACR的最大Youden指数均0.6,且高于相应的U-Alb浓度的Youden指数。结论目前临床应用的晨尿、随机尿微量白蛋白尿的临界值判定T2DM患者早期肾病的漏诊率较高,应重新建立T2DM患者晨尿、随机尿ACR及U-Alb的临界值,以利于DKD的早期防治。     

随机尿微量白蛋白肌酐比值在糖尿病及高血压肾损伤诊疗中的价值

目的 探讨随机尿微量白蛋白肌酐比值(ACR)在糖尿病及高血压肾损伤患者诊断及治疗中的价值.方法 糖尿病或高血压患者共62例(糖尿病30例,高血压32例),并按1989年Mogensen标准,根据尿白蛋白排泄率(UAER)分为三组:正常白蛋白尿组(UAER＜30mg/24h)20例,微量白蛋白尿组(UAER30～300mg/24h)20例,大量白蛋白尿组 (UAER＞300mg/24h)22例,均经内科正规治疗;留取24小时尿液计算UAER,治疗前后均留取随机尿测定尿微量白蛋白 (UmAlb)及尿肌酐进行比较.结果 随机尿ACR与UAER呈现明显的正相关(r=0.78,P＜0.01),与UmAlb也呈明显正相关(r=0.77,P＜0.01);肾损伤各组ACR及UmAlb检测结果比较中,UmAlb在对照组和正常白蛋白尿组比较无意义(P＞ 0.05),ACR则有显著差异(P＜0.01);在评价肾损伤的敏感性比较中,ACR在正常白蛋白尿组阳性率达35.0%,UmAlb阳性率仅5.0%,两者阳性率比较有显著差异(χ2=3.91,P＜0.05);治疗前后各组ACR及UmAlb检测结果比较中,正常白蛋白尿组的UmAlb治疗前后检测结果比较P＜0.05,ACR治疗前后检测结果比较P＜0.01.结论 随机尿ACR与UAER及UmAlb有着极好的相关性,在肾功能早期损伤的诊断及治疗后的疗效观察中均优于UmAlb,可以作为替代UAER及UmAlb作为肾病早期诊断及疗效观察的有效指标.     

晨尿和随机尿白蛋白肌酐比与尿蛋白定量在子痫前期的相关性分析

目的探讨子痫前期尿蛋白定量与晨尿和随机尿白蛋白肌酐的相关性。方法选取80例子痫前期患者作研究对象,均为我院2012年1月-2013年2月收治,对24h尿蛋白定量、随机尿ACR、晨尿ACR的相关性进行比较。结果尿蛋白平均5.9±2.5g/24h。随机ACR平均585.3±263.4mg/mmol,晨尿ACR平均572.7±251.4mg/mmol,24h尿蛋白定量与随机ACR系数（r=9.123）和晨尿ACR系数（r=0.928）具有高度相关性。结论就子痫前期尿ACR在临床诊断中的应用价值国内报道不多,且尿蛋白定量与子痫前期晨尿和随机尿的相关性报道不多。本次就相关内容进行探讨,晨尿ACR和随机尿ACR测定有较小差异,且时间相关限制较小,故随机尿ACR临床使用价值更显著,在临床可推广使用。     

24h尿蛋白和尿NAG与尿蛋白/肌酐比值及尿NAG/肌酐比值的相关性研究

目的探讨定量检测24 h尿液样本微量总蛋白(mTP)、微量白蛋白(mAlb)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)和肌酐(Cr)在肾脏疾病、糖尿病肾病方面的应用价值。方法采用邻苯三酚红/钼酸盐法、免疫散射比浊法、比色法和酶法分别测定81例不同肾脏疾病肾功能损伤患者24 h尿液样本中的mTP、mAlb、NAG和Cr水平,分别计算mTP/Cr比值、mAlb/Cr比值、NAG/Cr比值及其相关性。结果 81例患者24 h尿液样本中mTP、mAlb、NAG和Cr水平分别为185.0(40.0～987.5)mg/24 h、29.1(8.0～197.2)mg/24 h、20.3(8.8～37.9)U/24 h、0.83(0.63～1.08)g/24 h;mTP/Cr、mAlb/Cr、NAG/Cr比值分别为154.2(53.5～1 348.8)mg/gCr、60.1(14.8～376.2)mg/gCr、21.6(11.0～47.3)U/gCr,三者的相关系数(r)分别为0.973、0.884和0.718,均呈良好的正相关。结论 24 h尿mTP/Cr比值、mAlb/Cr比值、NAG/Cr比值可为肾脏疾病、糖尿病肾病的...     

人群调查中尿白蛋白检测方法的探讨

目的 探讨人群调查中尿白蛋白标本留取及检测方法.方法 选取659名北京市居民,收集其24 h尿测定UAER;并留取次日随机尿和晨尿,分别采用尿ACR及半定量尿白蛋白试纸法测定尿白蛋白.以24 h UAER作为标准,建立应用两种方法检测晨尿和随机尿白蛋白的ROC曲线,比较敏感度、特异度及ROC曲线下面积.结果 晨尿和随机尿ACR分别为9.36(5.12～33.29)mg/g及11.29(6.34～41.29)mg/g,组间比较差异无统计学意义(t=-1.382,P＞0.05),相关分析显示两者高度相关(r=0.932,P＜0.01).晨尿和随机尿ACR与24 h UAER具有高度相关性,相关系数分别为0.853及0.874,P均＜0.01.随机尿ACR诊断白蛋白尿的敏感度为77.9%,特异度为91.0%,晨尿ACR诊断白蛋白尿的敏感度为78.4%,特异度为95.7%.随机尿白蛋白试纸法诊断白蛋白尿的敏感度为90.3%,特异度为41.1%,特异度明显低于ACR法.随机尿与晨尿ACR的ROC曲线下面积分别为0.918±0.012及0.929±0.015,组间比较差异无统计学意义(χ2=2.13,P＞0.05).随机尿白蛋白试纸法ROC曲线下面积0.661±0.021,低于随机尿ACR(χ2=248.41,P＜0.01).结论 随机尿的ACR兼具简便及准确的特点,是人群调查中诊断白蛋白尿的良好指标.

Abstract：

Objective To evaluate the spot urine sample collection method and value of urinary albumin measurement in population survey. Methods Six hundred and fifty-nine Beijing residents were requested to collect 24 h urine for detection of UAER, as well as random spot urine samples and morning urine samples in the next day. Rapid semi-quantitative urinary albumin-specific dipstick and ACR were measured in each spot urine specimen. The 24 h UAER was measured as golden standard to generate ROC curves and evaluate the sensitivity, specificity and AUC of each method. Results The value of ACR in the morning spot urine samples and random spot urine samples were 9. 36(5. 12-33.29) mg/g and 11.29(6. 34-41.29) mg/g respectively and there was no significant difference between these two groups (t = - 1. 382,P＞0.05). The correlation was significant in the two groups (r = 0.932, P ＜ 0.01). The correlation coefficient between ACR in the morning spot urine samples and UAER was 0. 853 (P ＜ 0. 01). The correlation coefficient between ACR in the random spot urine samples and UAER was 0. 874 (P ＜0. 01).The sensitivity and specificity of ACR for diagnosis of albuminuria in the random urine samples were 77. 9% and 91.0%. The sensitivity and specificity of ACR for diagnosis of albuminuria in the morning urine samples were 78. 4% and 95.7%. Concerning the semi-quantitative urinary albumin-specific dipstick, sensitivity and specificity were 90. 3% and 41.1% , respectively. The specificity was much lower than that of ACR. The area under the ROC curves of ACR in the random urine specimens and the morning urine specimens was 0. 918 ±0. 012, 0. 929 ± 0. 015, respectively. There was no statistical difference between these two groups (χ2 =2. 13, P＞0. 05). The area under the ROC curves of semi-quantitative urinary albumin-specific dipstick in the random urine specimens was 0.661 ±0.021, lower than that of ACR (χ2 = 248.41, P＜0.01).Conclusion Measurement of ACR in random urine samples is a reasonable method with simplicity and accuracy for the detection of albuminuria in general population screening program.     

2型糖尿病患者晨尿微量白蛋白检测的可靠性

目的探讨2种不同尿液收集方法对尿微量白蛋白(Alb)测定结果的影响.方法连续3 d收集70例2型糖尿病(DM)患者的晨尿及24 h混合尿,并根据尿白蛋白(Alb)排泄率(UAE)不同分为3组,分别测定尿Alb、尿肌酐(Cr)及尿量.结果在3组DM患者中,晨尿Alb测定结果与24 h尿差异无显著性.相关系数(r)分别为0.884、0.990、0.970.晨尿Alb/尿Cr的比值与24 h尿Alb/Cr的比值无显著差异.r分别为0.891、0.993、0.987.结论收集晨尿测定尿微量Alb简便、迅速,受运动、体位等因素的影响小,对DM的早期诊断持异性高,适用于临床对DM的早期诊断及随访.     

24h尿蛋白和尿NAG与尿蛋白/肌酐比值及尿NAG/肌酐比值的相关性研究

目的探讨定量检测24 h尿液样本微量总蛋白（mTP）、微量白蛋白（mAlb）、N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和肌酐（Cr）在肾脏疾病、糖尿病肾病方面的应用价值。方法采用邻苯三酚红/钼酸盐法、免疫散射比浊法、比色法和酶法分别测定81例不同肾脏疾病肾功能损伤患者24 h尿液样本中的mTP、mAlb、NAG和Cr水平,分别计算mTP/Cr比值、mAlb/Cr比值、NAG/Cr比值及其相关性。结果 81例患者24 h尿液样本中mTP、mAlb、NAG和Cr水平分别为185.0（40.0～987.5）mg/24 h、29.1（8.0～197.2）mg/24 h、20.3（8.8～37.9）U/24 h、0.83（0.63～1.08）g/24 h;mTP/Cr、mAlb/Cr、NAG/Cr比值分别为154.2（53.5～1 348.8）mg/gCr、60.1（14.8～376.2）mg/gCr、21.6（11.0～47.3）U/gCr,三者的相关系数（r）分别为0.973、0.884和0.718,均呈良好的正相关。结论 24 h尿mTP/Cr比值、mAlb/Cr比值、NAG/Cr比值可为肾脏疾病、糖尿病肾病的正确判断提供实验室依据。     

胡桃夹综合征患者不同体位尿蛋白定量检测的日内变异分析

目的报道2例胡桃夹综合征患者随机尿微量清蛋白肌酐比(ACR)、总蛋白肌酐比(PCR)与24 h尿总蛋白定量(24hUTP)结果不一致的临床案例,并分析患者不同体位时随机尿蛋白的日内变异。方法用多普勒超声确诊2位患者为胡桃夹综合征,留取2位患者不同体位(平卧、正常活动)24 h期间所有尿标本,检测ACR、PCR、24hUTP,分析不同体位下ACR、PCR的变异及与24hUTP的一致性。结果平卧期间,2位患者随机尿ACR、PCR和24hUTP均在参考区间内,结果均一致;正常活动期间,2位患者随机尿ACR和PCR都有个别异常升高超出参考区间,24hUTP分别是0.21 g/24 h和0.05 g/24 h,结果严重不一致。结论胡桃夹综合征会引起体位性蛋白尿,从而导致患者随机尿蛋白日内变异较大,出现个别随机尿蛋白与24hUTP结果不一致的情况,建议患者用晨起第1次尿和24 h尿来监测尿蛋白的排泄情况。     

尿清蛋白检测性能评价及尿清蛋白/肌酐比值联合内生肌酐清除率对2型糖尿病患者肾损伤的检测意义

目的探讨尿清蛋白（Alb）检测性能评价及尿清蛋白/肌酐比值（ACR）联合内生肌酐清除率（Ccr）对2型糖尿病患者肾损伤的检测意义。方法收集2012年6月至2015年3月珠海市斗门区侨立中医院收治的110例2型糖尿病患者作为实验组。根据其检测结果将患者分为正常Alb尿组（≤30 mg/24 h尿）,微量Alb尿组（30~300 mg/24 h尿）,大量Alb尿组（≥300 mg/24 h尿）。选取同时期来我院进行体检的健康志愿者67例为对照组。收集所有研究对象24 h全部尿液、空腹静脉血4 ml,分离血清。-20℃保存,7 d内完成检测。测定标本中尿Alb、尿Cr、血Cr。根据慢性肾脏流行病学协作组发布的Ccr计算公式,对Ccr进行计算。结果患者T2DM的ACR为10.97 mg/24 h尿,Ccr为（75.36±8.47）ml/（min·1.73 m2）。联合检测ACR与Ccr水平,随着ACR含量的增高,Ccr水平下降明显。结论尿清蛋白/肌酐比值联合内生肌酐清除率可用于2型糖尿病患者肾损伤的早期诊断,辅助临床治疗。     

Diagnostic accuracy of the urinary albumin: creatinine ratio determined by the CLINITEK Microalbumin and DCA 2000+ for the rule-out of albuminuria in chronic kidney disease

An increased urinary albumin excretion (albuminuria) is an established test for the early detection of renal disease and is also recognized as a risk factor for cardiovascular disease and mortality in a number of clinical settings. There is an established body of data which shows that a random urinary albumin:creatinine ratio (ACR) based on a random urine sample correlates well with 24-hour urinary albumin excretion measurement. However, there is little data to show whether specific point-of-care testing devices can be used to rule-in or rule-out increased urinary albumin excretion in comparison to a 24-hour urinary albumin excretion measurement. This study evaluated the ability to rule-in or rule-out albuminuria in a cohort of patients attending a renal outpatient clinic, using the urinary ACR determined by the CLINITEK Microalbumin (Siemens Healthcare Diagnostics Inc., Deerfield, US) a semi-quantitative strip test, and by the DCA 2000+ (Siemens Healthcare Diagnostics Inc.) a quantitative cassette based test using 3 random urine samples collected within a 24-hour period compared to 24-hour urinary albumin measurement. The CLINITEK system was shown to be a reliable test for ruling out increased urinary albumin excretion with negative likelihood ratios less than 0.05 above the 24-hour urinary albumin excretion rate of 30 mg/24 h (threshold for microalbuminuria), and less than 0.01 above the albumin excretion rate of 100 mg/24 h. The DCA 2000+ system demonstrated similar performance as a rule-out test, with likelihood ratios of less than 0.02 at 24-hour albumin excretion rates above 30 mg/24 h. Both the CLINITEK and DCA 2000+ systems could be used to rule-out increased urinary albumin excretion at the albumin excretion cut-off rate of 30 mg/24 h in this cohort of patients.     

Comparison of urinary albumin excretion rate in overnight urine and albumin creatinine ratio in spot urine in diabetic patients in general practice

OBJECTIVE: To evaluate whether measurement of albumin creatinine ratio (ACR) on a spot urine specimen can replace a timed overnight collection of urine albumin excretion rate (UAER) in patients with diabetes in primary care. DESIGN: Patients with diabetes attending R?nvik Health Centre were asked to bring a timed overnight collection of urine for measurement of UAER. They were also asked to void a urine specimen for measurement of albumin creatinine ratio. SETTING: Primary health care. SUBJECTS: One-hundred-and-six persons with diabetes (47 women, 59 men) aged 13 to 78 years. RESULTS: The sensitivity and specificity of ACR with cut-off values of 2.5 mg/mmol for men and 3.5 mg/mmol for women compared to UAER with cut-off value of 20 mg/24 h was 90%. CONCLUSIONS: Spot urine ACR analysed on a DCA 2000 can replace a timed (overnight) collection of urine and measurement of UAER when diabetic patients are reviewed in general practice. This simplifies procedures for the patient as a timed urine collection is no longer necessary. Another advantage is that the results are available after 7 min.     

随机尿清蛋白肌酐比在高血压及糖尿病肾损伤早期诊断的应用价值

目的：探讨随机尿微量清蛋白肌酐比（ACR）在高血压及糖尿病致肾早期损伤的诊断应用价值。方法高血压和糖尿病患者共102例（糖尿病50例,高血压52例）,按1989年Mogensen标准,根24 h尿清蛋白排泄率（UAER）分为：正常组（UAER＜30 mg／24 h）、微量组（UAER 30～300 mg／24 h ）、大量组（UAER＞300 mg／24 h）。留取24 h尿检测 UAER ,并取随机尿同时测微量清蛋白（UmAlb）、尿肌酐（Cr）计算 ACR结果进行比较。结果随机尿ACR与24 h UAER呈现明显相关性,差异无统计学意义。在肾损伤的敏感性比较中,ACR的阳性率高于UmAlb ,差异有统计学意义。结论随机尿ACR与24 h UAER及UmAlb有极好的相关性,对肾损伤的诊断敏感性好于UmAlb ,ACR可以替代24 h UAER作为肾损伤早期诊断的有效指标。     

Smoking cessation A comparative,randomised study between management in general practice and the behavioural programme SmokEnders

Objective - To evaluate whether measurement of albumin creatinine ratio (ACR) on a spot urine specimen can replace a timed overnight collection of urine albumin excretion rate (UAER) in patients with diabetes in primary care. Design - Patients with diabetes attending Rønvik Health Centre were asked to bring a timed overnight collection of urine for measurement of UAER. They were also asked to void a urine specimen for measurement of albumin creatinine ratio. Setting - Primary health care. Subjects - One-hundred-and-six persons with diabetes (47 women, 59 men) aged 13 to 78 years. Results - The sensitivity and specificity of ACR with cut-off values of 2.5 mg/mmol for men and 3.5 mg/mmol for women compared to UAER with cut-off value of 20 mg/24 h was 90%. Conclusions - Spot urine ACR analysed on a DCA 2000 can replace a timed (overnight) collection of urine and measurement of UAER when diabetic patients are reviewed in general practice. This simplifies procedures for the patient as a timed urine collection is no longer necessary. Another advantage is that the results are available after 7 min.     

不同时段尿微量清蛋白对糖尿病早期肾损害的诊断价值

目的探讨2型糖尿病肾病患者不同时段尿微量清蛋白(u-MA)变化及其对2型糖尿病患者早期肾损伤的诊断价值。方法收集糖尿病肾病患者组(n=27)和健康对照组(n=30)连续3 d的晨尿、餐后尿、随机尿和24 h尿,进行尿微量清蛋白测定。结果糖尿病患者尿微量清蛋白排泌高峰为餐后尿(61.7±26.5 mg/L),其次为晨尿(58.9±23.5 mg/L)和24 h尿(56.6±13.2 mg/L),3者显著高于随机尿(37.2±21.4 mg/L)(P<0.05),且各时段尿微量清蛋白都有较大的日间差异,以随机尿差异最大CV=57.5%,餐后尿、晨尿、和24 h尿分别为42.9%、39.9%和23.3%,糖尿病肾病患者各时段尿微量清蛋白与对照组比较差异有统计学意义(P<0.05)。结论餐后尿和晨尿微量清蛋白含量的多次检测有利于提高2型糖尿病患者早期肾损害的诊断。     

Assessment of the diurnal variations in urinary homovanillic and vanillylmandelic acid excretion for the diagnosis and follow-up of patients with neuroblastoma

The diurnal variation of urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA) was studied in neuroblastoma patients and in a control group. Urinary HVA and VMA levels in four sequential 6-hour urine collections within a 24-hour period were compared. HVA and VMA levels were expressed in microgram/mg of urinary creatinine (UCr) and in mg/6h specimens. No statistically significant variations between the four time intervals were found when expressed in microgram/mg UCr or mg/6h. The small variations that exist in the excretion of HVA and VMA during different periods of the day are due to variations in renal excretion rather than variations in production. The results from this study indicate that a random urine sample should be as good as a 24-hour collection for diagnosis and follow-up of neural crest tumors.