尿白蛋白/肌酐比值对诊断早期糖尿病肾病的价值

随着糖尿病病程的进展肾亦受累,近年来研究证实尿白蛋白/肌酐比值是诊断早期糖尿病肾病的敏感指标。本文综述了它对诊断早期糖尿病肾病的价值。     

中国汉族人以尿白蛋白肌酐比值诊断微量白蛋白尿的界值研究

目的 探讨中国汉族人群以晨尿白蛋白肌酐比值（ACR）诊断微量白蛋白尿（MA）的界值。 方法 本研究对象来自于北京平谷区代谢综合征肾损害流行病学调查,随机整群抽取的部分受试者除外脓尿或者镜下血尿后自愿留取8 h过夜尿。以8 h尿白蛋白排泄率（UAE）作为诊断标准,应用受试者工作特征曲线（ROC）方法确定MA的诊断界值。 结果 （1）共1056人（男性494人、女性562人,年龄20~75岁）纳入本研究,MA的患病率为12.5%,临床蛋白尿患病率为1.7%。（2）ROC确定诊断MA的ACR下界值：男性1.95 g/mol（敏感性97.6%,特异性88.6%）,女性3.62 g/mol（敏感性83.8%,特异性89.1%）,总体受试者ACR下界值为2.78 g/mol（敏感性88.7%,特异性86.0%）;上界值：总体受试者ACR上界值为22.59 g/mol（敏感性100.0%,特异性98.8%）。（3）与8 h尿UAE诊断MA的一致性检验显示本研究按性别区分的诊断界值敏感性91.3%,特异性88.2%,阳性及阴性似然比为7.96和0.10,阳性及阴性预测值为56.9%和98.4%。 结论 晨尿诊断MA的ACR下界值存在性别差异,男性1.95 g/mol,女性3.62 g/mol,较目前国际推荐的性别特异性ACR诊断值偏高,具有良好的诊断性。     

血清单核细胞/高密度脂蛋白胆固醇比值、尿白蛋白/肌酐比值对糖尿病肾病患者发生骨质疏松的评估价值

目的探讨血清单核细胞/高密度脂蛋白胆固醇比值(monocyte-to-HDL cholesterol ratio, MHR)、尿微量白蛋白和肌酐比值(albumin-to-creatinine ratio, ACR)对糖尿病肾病(diabetic nephropathy, DN)患者发生骨质疏松的评估价值。方法选择2019年6月至2022年6月于杭州市第九人民医院治疗的117例DN患者作为研究对象。收集并记录所有患者的性别、年龄、身高、体重, 计算身体质量指数(body mass index, BMI);检测并记录所有患者的血钙(calcium, Ca)、血磷(phosphorus, P)、甲状旁腺激素(parathyroid hormone, PTH)、单核细胞计数(monocyte count, M)、高密度脂蛋白(high-density lipoprotein, HDL-C)、尿微量白蛋白和肌酐, 计算MHR和ACR, MHR=M/HDL-C, ACR=尿微量白蛋白/肌酐。采用双能X线骨密度仪检测腰椎(L1～L4)骨密度, 将117例患者分为骨质疏松组和非骨质疏松组。结果 11...     

糖尿病患者微量白蛋白尿的检测方法

微量白蛋白尿是早期糖尿病肾病的标志,也是心血管病的独立危险因子.因此糖尿病防治指南中建议对患者的微量白蛋白尿进行筛查.但是,微量白蛋白尿的检测方法有很多种,被称为金标准的24 h白蛋白定量在实际工作中常遇到方法繁琐、记录不准确、膀胱不能完全排空等问题,限制了它的应用.本文的目的在于比较24 h白蛋白定量以及随机尿样白蛋白定量间的准确性与敏感性,探讨新的微量白蛋白尿的检测方法.     

糖尿病患者血浆瘦素与尿白蛋白排泄率相关性的研究

目的：对2型糖尿病病人的血浆瘦素进行测定,并探讨血浆瘦素与糖尿病肾病的关系。方法：收集我院2001年1月1日-2003年4月内分泌科住院的2型糖尿病患者65例,将其分为临床糖尿病肾病组18例,早期糖尿病肾病组25例,无糖尿病肾病组22例,另设健康对照者30例。采用放射免疫法测定血浆瘦素水平与尿白蛋白排泄率。结果：临床糖尿病肾病组、早期糖尿病肾病组、无糖尿病肾病组及对照组血浆瘦素分别为17．41±5．81、13．32±6．78、9．52±4．34、5．1±3．4。临床糖尿病肾病组、早期糖尿病肾病组、无糖尿病肾病组分别与对照组比较均有统计学差异（P〈0．01）;临床糖尿病肾病组、早期糖尿病肾病纽分别与无糖尿病肾病组比较均有统计学差异（P〈0．01）;临床糖尿病肾病组与早期糖尿病肾病组比较有统计学差异（P〈0．01）;同时各糖尿病组血浆瘦素与尿白蛋白排泄率呈正相关。血浆瘦素水平与年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、胆固醇、三酰甘油等无相关关系。结论：血浆瘦素参与2型糖尿病肾病致病的过程,并且是2型糖尿病肾病发病的一种独立危险因子。     

免疫比浊法测定微量白蛋白尿以早期诊断糖尿病肾病

目的：（１）通过比较ＤＣＡ２０００测定仪（免疫比浊法）与常规放射免疫法测定尿白蛋白结果，评价使用ＤＣＡ２０００测定尿白蛋白的可靠性及准确性；（２）比较不同标本采集方式对尿白蛋白结果及糖尿病肾病分期的影响。方法：（１）用１１７名病人的夜间８ｈ尿标本分别进行ＤＣＡ２０００免疫比浊法和放射免疫法测定；（２）以ＤＣＡ２０００测定仪测定３４例患者的晨尿、８ｈ及２４ｈ尿白蛋白、肌酐浓度。结果：（１）ＤＣＡ２０     

依那普利与阿魏酸哌嗪对降低2型糖尿病患者尿微量白蛋白的初步观察

糖尿病肾病是糖尿病慢性并发症之一 ,尿白蛋白检测作为糖尿病肾病的敏感指标 ,已得到国内外公认〔1〕。本实验旨在观察依那普利与阿魏酸哌嗪片对降低正常血压早期糖尿病肾病尿微量白蛋白的影响观察。资料与方法1　临床资料　 6 0例 2型糖尿病患者均符合 1985年ＷＨＯ诊断标准。血压在正常范围 (12 .0ｋＰａ <收缩压 <18.0ｋＰａ、8.0ｋＰａ <舒张压 <12 .0ｋＰａ)。连续 2ｄ检测尿微量白蛋白 2次 ,均在 2 0～ 2 0 0 μｇ/ｍｉｎ之间。随机分组 :治疗组 30例 (Ａ组 ) ,男 16例 ,女 14例 ;平均年龄 (45 .2 1±10 .15 )岁 ,病程 (8.1± 4 .1)年…     

尿蛋白与尿肌酐比值的测定

尿蛋白持续增多是慢性肾损伤的重要标志。尿蛋白的检测为发现多种肾脏病早期到进展阶段提供了一个敏感的指标,对慢性肾脏病（CKD）治疗和判断预后具有重要意义。本文介绍了尿蛋白检测的4种方法,对比了各种尿蛋白检测的优缺点和临床意义以及大致对应关系,强调尿蛋白与尿肌酐比值检测的重要性。     

黄连素对2型糖尿病患者24h尿微量白蛋白的影响

目的：观察黄连素对2型糖尿病患者血肌酐（Scr）、尿素氮（BUN）、24h尿微量白蛋白（24hUAlb）的影响。方法：我院门诊收治的2型糖尿病患者60例,随机分为治疗组（黄连素组）和对照组（罗格列酮组）。服药前后3月分别测定Scr、BUN、24hUAlb、空腹血糖（FPG）、糖化血红蛋白（HbA1C）、血脂,并计算胰岛素抵抗指数（HOMA-IR）。结果：治疗组3月后24hUAlb、FPG、HbA1C、HOMA-IR、血脂较治疗前均下降,差异有统计学意义（P〈0.05）,Scr、BUN亦下降,但差异无统计学意义（P〉0.05）。对照组3月后24hUAlb、FPG、HbA1C、HOMA-IR、血脂较治疗前均下降,差异有统计学意义（P〈0.05）,BUN、Scr差异无统计学意义（P〉0.05）。结论：黄连素可减少2型糖尿病患者24h尿微量白蛋白排泄,其作用可能和黄连素的降脂、降糖、改善胰岛素抵抗等有关,但对肌酐、尿素氮作用不显著,提示黄连素对糖尿病肾病的早期预防有积极意义,值得临床进一步研究。     

Use of albumin creatinine ratio and urine albumin concentration as a screening test for albuminuria in an Indo-Asian population.

BACKGROUND: Albuminuria (>30 mg/day) based on 24 h urine albumin excretion is one of the criteria for chronic kidney disease (CKD) and a predictor of cardiovascular disease (CVD). Differences in urine albumin concentration and creatinine excretion rates between Indo-Asians and other populations may require different threshold values for detection of albuminuria. We compared the use of spot urine albumin concentration and urine albumin to creatinine excretion ratio for detection of albuminuria in this population. METHODS: A total of 577 subjects aged >or=40 years, 54% of whom were women, were recruited from the general population in Karachi, Pakistan. Albumin concentration (mg/l) and albumin to creatinine ratio (mg/g of creatinine) were determined in a spot morning urine sample, and albuminuria (30 mg/day or greater) measured in a 24 h urine collected on the subsequent day. RESULTS: The median (25-75 percentile) of urine albumin excretion was 4.8 (3.6-10.3) mg/day: 5.4 (3.7-12.5) mg/day in men and 4.5 (3.8-8.9) mg/day in women. The overall prevalence (95% CI) of albuminuria was 11.8% (7.2-12.0%): 14.8% in men and 9.2% in women (P = 0.04). The areas under the receiver operator characteristic (ROC) curves for urine albumin concentration were 0.86 (0.82-0.90) and 0.88 (0.84-0.92), respectively, in women and men. The areas under the ROC curves for albumin to creatinine ratio were 0.86 (0.82-0.89) and 0.90 (0.86-0.93), respectively, in women and men. For urine albumin concentration, the sensitivity and specificity were 37 and 97%, respectively, in women and 69 and 94%, respectively, in men at the conventionally recommended value of 2 mg/dl. The discriminator value of urine albumin concentration identified in the analysis was 0.5 mg/dl in women (sensitivity of 87% and specificity of 75%) and 1.7 mg/dl in men (sensitivity of 74% and specificity of 93%). For the albumin to creatinine ratio, the sensitivity and specificity were 46 and 95%, respectively, in women and 60 and 97%, respectively, in men at cut-off value of 30 mg/g. CONCLUSION: Both urine albumin concentration and albumin to creatinine ratio are acceptable tests for population screening for albuminuria in Indo-Asians. While sensitivities may be suboptimal, particularly in women, lowering the existing thresholds would compromise specificity. Those who screen positive need evaluation and management of CKD and prevention of CVD.     

Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race

The recommended albumin (microg)/creatinine (mg) ratio (ACR) (30 microg/mg) to detect microalbuminuria does not account for sex or racial differences in creatinine excretion. In a nationally representative sample of subjects, the distribution of urine albumin and creatinine concentrations was examined by using one ACR value (> or =30 microg/mg) and sex-specific cutpoints (> or =17 microg/mg in men and > or =25 microg/mg in women) measured in spot urine specimens. Mean urine albumin concentrations were not significantly different between men and women, but urine creatinine concentrations were significantly higher (P < 0.0001). Compared with non-Hispanic whites, urine creatinine concentrations were significantly higher in non-Hispanic blacks (NHB) and Mexican Americans, whereas urine albumin concentrations were significantly higher in NHB (P < 0.0001) but not Mexican Americans. When a single ACR is used, the prevalence of microalbuminuria was significantly lower among the men compared with women (6.0 versus 9.2%; P < 0.0001) and among non-Hispanic whites compared with NHB (7.2 versus 10.2%; P < 0.0001). No significant difference in the prevalence of microalbuminuria between men and women was noted when sex-specific ACR cutpoints were used. In the multivariate adjusted model, female sex (odds ratio, 1.62; 95% confidence interval, 1.29 to 2.05) and NHB race/ethnicity (odds ratio, 1.34; 95% confidence interval, 1.12 to 1.61) were independently associated with microalbuminuria when a single ACR threshold was used. When a sex-specific ACR was used, NHB race/ethnicity remained significantly associated with microalbuminuria but sex did not. The use of one ACR value to define microalbuminuria may underestimate microalbuminuria in subjects with higher muscle mass (men) and possibly members of certain racial/ethnic groups.     

Increasing sex difference in bone strength in old age: The Age, Gene/Environment Susceptibility-Reykjavik study (AGES-REYKJAVIK)

INTRODUCTION: It is important to identify possible pathological mechanisms that underlie the known sexual dimorphism in bone fragility in old age. In this cross-sectional population-based study, we use data from three different skeletal sites to examine sex differences in volumetric bone density, geometry and strength indices and determine whether sex differences in these bone strength measures continue to increase into very old age. MATERIALS AND METHODS: A total of 1715 elderly individuals (807 men and 908 women) age 67-93 years, participants in a population-based study, the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-REYKJAVIK) and not taking medications affecting bone metabolism, were studied. Quantitative computed tomography (QCT) was performed in the lumbar spine, hip and mid-femoral shaft to estimate volumetric trabecular, cortical and integral BMD, bone geometry and bone strength indices. Regression models were used to assess the effects of age and gender-adjustment for standing midlife height and current weight. RESULTS: At age 67-69 years, men had 24.9-31.7% larger cross-sectional bone size at measured sites than women. At all bone sites, women had two- to fivefold diminution in net bone mass with age compared to men but had comparable increments in bone size (1.8-6.0% per 10 years). This was reflected in significantly worse (more than twofold) bone strength measures with age in women, including compressive strength indices at the spine, femoral neck and trochanter and bending strength indices at the femoral neck. CONCLUSION: With the limitations of a cross-sectional study, our data support the hypothesis that sex differences in bone strength continue into old age. These sex differences appear to be due to greater net bone loss in women rather than due to greater bone gain in men.     

The effect of age on serum creatinine levels in an aging population: relevance to vascular surgery

BACKGROUND AND AIM: Serum creatinine is commonly used to assess and monitor renal function in the management of abdominal aortic aneurysm with endoluminal grafting, and for intervention of renal artery occlusive disease. The majority of patients selected for these procedures are elderly and serum creatinine is used post-operatively to monitor renal function. There is a need to adjust the serum creatinine concentration for age to determine the changes that might be due to the procedure: especially with endoluminal grafting using transrenal manipulation and fixation, and procedures involving interventions directly on the renal arteries. A single reference interval for serum creatinine is usually given for each sex but does not take into account variation due to age. The objective of this study was to establish age related reference intervals for serum creatinine, especially for those over 60 years of age to assist in the clinical interpretation of creatinine levels in the years following endoluminal grafting for aneurysms of the abdominal aorta. METHODS: A pathology services database was established for serum creatinine measurements from 98,688 patients (44,784 males and 53,904 females). Data was stratified into five year age groups and reference intervals assigned for each age group after a reference population was determined. The heterogeneous population was refined firstly by removing patients with extreme (> or =200 micromol/l) concentrations of serum creatinine, outliers and repeated values. Secondly, a putative "healthy" population was determined by removing values outside three standard deviations of the mean. Two statistical methods, the Bhattacharya and Hoffmann methods, were then applied to obtain a putative reference population. Serum creatinine data was obtained from the Busselton Population Research Foundation for comparison. FINDINGS: Serum creatinine concentration increased steadily with age; in females from the age of 40 years and 60 years for males. Reference intervals for males and females aged from 20 to 94 years were established. Advancing age affects serum creatinine levels, especially in the "vascular" age group of 60 to 80 years. The changes in serum creatinine concentration that occur with age is relevant in interpretation of the results of renal monitoring after intervention.     

Genomewide linkage analysis to serum creatinine, GFR, and creatinine clearance in a community-based population: the Framingham Heart Study

Kidney disease is a risk factor for the development of cardiovascular disease, all-cause mortality, and ESRD. It is not known to what extent genetic factors play a role in the development of kidney disease in the general population. Multipoint variance components linkage analysis was performed using Genehunter on 330 families from the Framingham Heart Study offspring cohort, using a 10-cM genomewide scan for serum creatinine, GFR, and creatinine clearance (CRCL) measured from 1998 to 2001. GFR was estimated using the simplified Modification of Diet in Renal Disease Study equation, and CRCL was estimated using the Cockcroft-Gault equation. Covariates in the adjustment included age, gender, body mass index, diabetes, systolic BP, hypertension treatment, tobacco use, and HDL cholesterol. Overall, 1224 subjects (52% women), mean age 59, were available for analysis. Mean creatinine was 0.87 mg/dl, mean GFR was 87 ml/min per 1.73 m(2), and mean creatinine clearance was 100 ml/min. The multivariable-adjusted heritability estimates for creatinine, GFR, and CRCL were 0.29, 0.33, and 0.46, respectively. The peak log of the odds ratio (LOD) scores for serum creatinine, GFR, and CRCL were 2.28 at 176 cM on chromosome 4, 2.19 at 78 cM on chromosome 4, and 1.91 at 103 cM on chromosome 3, respectively. In a community-based sample, measures of serum creatinine, GFR, and CRCL are heritable, suggesting an underlying genetic component. These results also provide suggestive evidence for linkage to measures of kidney function. Further research is necessary to identify the genes involved in the development of kidney disease and to understand their roles in this complex process.     

Diagnostic and therapeutic laparoscopy in acute cholecystitis in middle and old age]

Laparoscopic decompression of the gallbladder in elderly and senile patients having acute cholecystitis and in patients with severe coexistent diseases allows arresting the acute inflammatory process in the gallbladder, reducing the amount of forced operations which are extremely dangerous for this contingent of patients. Sanitation of the gallbladder with the electrolytic silver solution and irradiation of the bladder mucosa with laser is highly effective. Microcholecystostoma performed with a catheter having a diameter not less than 2.5 mm maintains adequate decompression of bile ducts and allows performing complete examination of them.     

The association between albumin to creatinine ratio and total protein to creatinine ratio in patients with chronic kidney disease

Aims: Although albumin to creatinine ratio (ACR) and total protein to creatinine ratio (PCR) in random urine have been supposed as alternatives to 24-h urine measurements, there are few studies comparing these tests in CKD patients. Therefore, we investigated the relations between ACR and PCR in CKD patients and the factors that affect the relationship. Methods: We enrolled 808 patients with CKD prospectively and compared ACR, PCR and urine dipstick test in random urine. Results: Albuminuria was well correlated with proteinuria (β = 1.114, p < 0.001). The association between albuminuria and proteinuria was greater in patients with following characteristics: dipstick protein positive compared with negative (p < 0.001 for interaction), urine creatinine level ≥ 60 mg/dl compared with < 60 mg/dl (p = 0.024 for interaction) and estimated glomerular filtration rate < 60 ml/min/1.73 m2 compared with ≥ 60 ml/min/1.73 m2 (p = 0.040 for interaction). However, the association between albuminuria and proteinuria was not affected by sex, the presence of diabetes, or old age (≥ 60 years). Conclusions: Both ACR and PCR in random urine are correlated well and can be used for monitoring of protein excretion in CKD patients, alternatively. However, the correlation is not strong in patients with low amount of protein excretion or with low urinary creatinine concentration.     

Performance of a reagent strip device for quantitation of the urine albumin: creatinine ratio in a point of care setting

AIM: We have evaluated the performance of a reagent strip (Clinitek, Bayer plc, Newbury) incorporating a novel dip and read device for the quantitation of the albumin: creatinine ratio together with their individual concentrations in urine. METHODS: The performance was compared with that of a lateral flow device for the semi-quantitation of albumin (Micral II, Roche Diagnostics, Lewes) and also a laboratory based procedure. The device employs novel methods for both analytes, using a sulphonephthalein dye binding at pH 1.5 for albumin and the peroxidase-like activity of copper creatinine complexes. The color yields of the separate reaction pads are monitored with the Clinitek 50TM bench top urine chemistry analyzer and compared to a pre-programmed calibration algorithm. RESULTS: The imprecision of the device was assessed by observing the discrepancy between duplicates in a total of 144 urine samples collected from patients with diabetes and/or renal disease; there were 10 discrepancies in the case of the albumin estimation (6.9%), 12 in the case of the creatinine estimation (12.5%) and 23 in the case of the albumin: creatinine ratio (16.0%). In the case of the Micral II, where 96 of the urines were analyzed there were 12 discrepancies (12.5%). When considered as a two-class test for albumin with a cut off of 20 mg/L the Clinitek gave a sensitivity of 95.4% with specificity of 78.9% and a positive predictive value of 87.4%. When analyzing four urines (two controls, two patient pools) with replicate analysis on the Clinitek system we found 100% agreement for the albumin estimation, 95% for creatinine and 96.7% for the albumin: creatinine for 60 analysis within a day and 100, 95 and 97.5% on single analyses each day for 20 days for the two urine controls. The discrepant results were always within one color block. When considering the albumin: creatinine ratio with a cut off of < 30 mg/g the Clinitek gave a sensitivity of 76.3% with a specificity of 89.1% and a positive predictive value of 89.7%. CONCLUSION: The Clinitek system provides a reliable means to screen for microalbuminuria with the opportunity of a semi-quantitative assessment when microalbuminuria is found.