尿微量白蛋白/尿肌酐比值检测在老年人心血管疾病防治中的应用

尿微量白蛋白能够反映肾脏异常渗漏的蛋白质,其增高多见于糖尿病肾病、高血压、妊娠子痫前期,是肾损伤的早期敏感指标,通常应用尿微量白蛋白来监测肾病的发生。肾脏损伤程度多以24 h尿蛋白定量测定进行评估,但因留取24 h标本困难,在实际应用上受到限制。随机尿测定是目前最常用,最易     

社区老年人群尿微量白蛋白/尿肌酐比值与心血管病危险因素的关系

目的 研究社区65岁及以上老年人群尿微量白蛋白/尿肌酐比值(UACR)现况及其与心血管病危险因素的关系.方法 对"十一五"国家科技支撑计划"慢性心力衰竭早期预警和失代偿期综合防治的研究"的社区队列研究中一个农村社区所有65岁及以卜老年人进行包括心血管病危险因素在内的基线情况调查,并留取清晨点时间尿样检测尿微量白蛋白、尿肌酐和UACR等,分析UACR在健康人群以及具有心血管病危险因素人群中的分布情况.结果 (1)完成调查的65岁及以上老年人共1718名,其中男性721名,女性997名,年龄(73.3±5.5)岁.(2)调查的老年人群中,有至少1种心血管病危险因素者占78.00%,患病率排在前3位的心血管病危险凶素依次是血脂异常、高血压和糖尿病,其患病率分别为61.06%、44.59%和13.80%.(3)健康人群UACR中位数为13.81(6.03～26.51)μg/mg,其中男性为5.49(2.92～9.76)μg/mg,女性为17.12(7.28～33.28)μg/mg,女性显著高于男性(P<0.01).(4)具有高血压、糖尿病和血脂异常人群的UACR分别为16.27(6.65～42.00)μg/mg、26.27(10.92～76.65)μg/mg和16.39(6.98～41.03)μg/mg,均高于健康人群(P<0.05或P<0.01).(5)具有0、1、2,3和4个心血管病危险因素人群的UACR中位数分别为13.81(6.03～26.51)μg/mg、15.76(6.79～36.44)μg/mg、13.82(5.68～34.43)μg/mg、16.47(6.07～50.56)μg/mg和18.63(11.26～83.09)μg/mg,具有4个危险因素人群的UACR水平显著高于无危险因素人群(P<0.05).结论 65岁及以上社区老年人群患病率排在前3位的心血管病危险因素依次是血脂异常、高血压和糖尿病,三者均与UACR增高有关.

Abstract：

objective To determine the value of the urinary microalbumin/creatinine ratio (UACR)and the relationship between UACR and traditional cardiovascular risk factors among elderly community subjects.Methods A representative population in Shanghai rural district aged more than 65years who participated in the heart health survey of the key projects in the national science and technology pillar program in the eleventh five-year plan period of China were sampled via a clustered complex sampling method.A midstream collection from the first morning void collected was used to measure the urinary microalbumin,the urinary creatinine and the UACR.Baseline information including traditional cardiovascular risk factors were obtained by standard questionaire to analyze the distribution status of UACR in the population with or without the risk factors.Results (1)There were 1718 subjects(721 males)of(73.3±5.5)years included in this study.(2)The prevalence of with at least one cardiovascular risk factor was 78.00%in this cohort,the top there risk factors were dyslipidemia(61.06%),hypertension(44.59%)and diabetes(13.80%).(3)The median(the lower quartile-the upper quartile)of the UACR of the population without cardiovascular diseases and risk factors was 13.81(6.03-26.51)μg/mg.The level of UACR was significantly higher in females than that in males[17.12(7.28-33.28)μg/mg vs.5.49(2.92-9.76)μg/mg,P<0.01].(4) The level of UACR in population with hypertension,diabetes or dyslipidemia was 16.27(6.65-42.00)μg/mg,26.27(10.92-76.65)μg/mg and 16.39(6.98-41.03)μg/mg respectively,all exceeding that of the healthy group(P<0.05 or P<0.01).(5)The levels of UACR increased in proportion to the increase of cardiovascular risk factor numbers, the UACR of the population with 0, 1,2, 3 and 4 cardiovascular risk factors were 13. 81 (6. 03 - 26. 51 ) μg/mg, 15.76(6.79-36.44)μg/mg, 13.82 (5.68-34.43) μg/mg, 16.47 (6.07-50.56) μg/mg and 18.63( 11.26 - 83.09 ) μg/mg, respectively. The population with 4 cluster of cardiovascular risk factors posed the higher level of UACR than that of population with 0 cardiovascular risk factors ( P < 0. 05 ). Conclusions The three most common risk factors of cardiovascular diseases among the elderly community subjects aged more than 65 years are dyslipidemia, hypertension and diabetes, all of which are related to the elevation of UACR.     

尿微量白蛋白／肌酐比值与24h尿微量白蛋白相关性分析

收集224例T2DM患者24h尿和晨尿,分别测定24h尿mALB、晨尿mALB、Cr,进行晨尿ACR与24h尿mALB的相关性分析。结果：晨尿ACR与24h尿mALB呈高度相关。结论：晨尿ACR可替代24h尿mALB作为观察评价尿微量白蛋白排泄量的指标并用于糖尿病肾病早期筛查。     

原发性高血压患者认知功能与微量白蛋白尿

目的 探讨原发性高血压(EH)患者认知功能损害与微量白蛋白尿的关系.方法 采集200例体检高血压病患者的一般资料,测量血压、身高、体重,测定空腹血糖,空腹胰岛素,总胆固醇,甘油三酯,餐后2 h血糖,餐后2 h胰岛素及尿蛋白,对尿蛋白阴性的患者再测定尿微量白蛋白和尿肌酐,最后评价患者的危险分层.根据国际通用的简易智力状况量表(mini mental stateexamination,MMSE)得分进行认知功能评定,按国际标准24分为分界值,将患者分为2组:24分为认知功能正常组,≤24分为认知功能障碍组.结果 200例EH患者,尿蛋白阳性25例,尿蛋白阴性175例.卡方检验结果 提示,尿蛋白阳性与尿蛋白阴性患者之间认知功能差异无统计学意义(P0.05);175例患者测定尿微量白蛋白,进行单因素分析,结果 显示:年龄、文化程度、职业、吸烟史、冠心病史、脑血管病史、危险分层、尿微量白蛋白与尿肌酐比值、餐后2 h胰岛素、胆固醇及舒张压11个因素在认知功能正常组和认知功能障碍组之间的差异有统计学意义(P<0.05);对175例患者进行logistic多因素回归分析显示,与认知功能下降有关的指标是:文化程度、危险分层及尿微量白蛋白.结论 本研究的EH人群文化程度、危险分层和尿微量白蛋白与认知功能降低密切相关,而微量白蛋白尿独立于其他危险因素与认知功能障碍的发生有关,提示微量白蛋白尿可能是认知功能障碍的独立危险因素.     

原发性高血压尿白蛋白/肌酐比值与血压水平及血压变异的关系

目的 探讨原发性高血压患者尿白蛋白/肌酐比值与血压及血压变异的关系.方法 根据《2010年中国高血压防治指南》的血压标准,筛选出104例高血压患者,并据血压的数值分为1、2、3级高血压,以此把高血压组分为3个实验组,并以同期我院体检中心健康体检者45例为对照组,所有对象均进行无创性24小时动态血压监测,次日清晨留取尿,测定尿微量白蛋白与尿肌酐的水平.结果 与正常对照组相比,高血压组尿白蛋白/肌酐比值明显升高,且随着血压的增高而增高;直线相关分析显示,尿白蛋白/肌酐比值水平与24小时平均收缩压、24小时平均舒张压均呈显著正相关（相关系数r分别为0.709和0.675,P值分别为0.000和0.042）.尿白蛋白/肌酐比值与24小时收缩压变异系数、24小时舒张压变异系数呈显著正相关（相关系数r分别为0.922和0.628,P值分别为0.000和0.000）.多元逐步回归分析表明：校正血糖、胆固醇、三酰甘油、体重指数、病程后,24小时平均收缩压、24小时平均舒张压、24小时收缩压变异系数仍与尿白蛋白/肌酐比值水平有显著的相关性,24小时舒张压变异系数与尿白蛋白/肌酐比值的水平无显著的相关性.结论 微量白蛋白尿是高血压肾损害的早期表现,高血压肾损害的程度不仅与血压水平升高有关,而且与血压变异性关系密切.     

尿微量白蛋白/尿肌酐比值在糖尿病肾病患者诊断中的临床价值

214例糖尿病患者留取晨尿和24小时尿,按GFR分组,测定晨尿UMA/UCr比值,与24hUMA及24hUA1定量进行相关性分析。应用ROC曲线分析UMA/UCr比值对于24hUA1蛋白〉0.15g、〉1.0g的诊断界值。结果：除GFR≤30m l/m in组外,其余组尿微量白蛋白/尿肌酐比值与24小时尿微量白蛋白及24HUA1定量均呈明显正相关。UMA/UCr比值对于24hUA1〉0.15g、〉1.0g的诊断界值分别为40.53mg/g和191.23mg/g。结论：晨尿UMA/UCr可以替代24hUMA作为早期诊断DN。     

血脂康对轻度高血压伴尿微量白蛋白的影响

目的探讨血脂康对轻度高血压伴尿微量白蛋白的影响。方法将40例轻度高血压伴尿微量白蛋白患者随机分为两组。对照组采用常规治疗;治疗组在常规治疗基础上加用血脂康（每天2次,每次0．6g）。12周后,比较两组治疗前、后尿微量白蛋白肌酐比值的变化。结果治疗组尿微量白蛋白肌酐比值下降,差别有统计学意义（P〈0．05）。结论血脂康能降低轻度高血压伴微量白蛋白尿患者的尿微量白蛋白肌酐比值,减少尿微量白蛋白的排泄。     

老年杓型高血压患者晨峰血压现象与尿微量白蛋白/肌酐的关系

目的：研究老年杓型高血压患者的晨峰血压（MBPS）现象与尿微量白蛋白/肌酐（UmAlb/Cr）的关系,明确其对肾脏功能的潜在损害。
　　方法：收集225例老年杓型高血压患者,根据动态血压监测（ABPM）结果分为观察组（有晨峰血压的102例）及对照组（无晨峰血压的123例）,均行UmAlb/Cr、血尿素氮（BUN）、肌酐（Cr）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）、胆固醇（TC）检测,分析两组间UmAlb/Cr的差异。
　　结果：两组患者之间的性别例数比、病程、年龄、血BUN、Cr、HDL-C、LDL-C、TG、TC差异无统计学意义（P>0.05）。观察组较对照组的血压晨峰变异幅度显著升高[（△晨峰血压mmHg（：33.82±8.26）比（14.01±6.15）,P=0.01）]。不同性别观察组UmAlb/Cr均高于对照组[mg/mmol：男性（4.92±1.91）比（2.48±1.95）,P=0.001,女性（5.49±2.04）比（3.95±2.37）,P=0.03]。
　　结论：具有MBPS现象的老年杓型高血压患者较无MBPS现象者更易出现早期肾功能损害。     

2型糖尿病患者踝臂指数与尿微量白蛋白／肌酐比值的相关性

目的 探讨2型糖尿病（T2DM）患者踝臂指数（ABI）与尿微量白蛋白/肌酐比值（UACR）的相关性.方法 将141例2型糖尿病患者分为正常ABI组（0.9≤ABI＜ 1.4,99例）和异常ABI组（ABI＜ 0.9,42例）,分析两组的性别、年龄、病程、体重指数（BMI）、UACR、尿素氮（BUN）、总胆固醇/三酰甘油（TC/TG）、糖化血红蛋白（HbA1c）等指标.结果 与正常ABI组比较,异常ABI组患者的病程、BUN、UACR、HbA1c水平升高,两组比较差异有统计学意义（P＜0.05）.ABI与病程、UACR、BUN呈负相关（相关系数分别为-0.634、-0.757和-0.578,P均＜0.01）.结论 ABI与UACR呈负相关.异常ABI具有重要预警意义,能较早期地反映糖尿病患者肾功能的受损,对于筛查早期糖尿病肾病有重要临床意义.     

2型糖尿病患者尿微量白蛋白/肌酐比值与臂踝脉搏波传导速度的相关性

目的 探讨2型糖尿病患者尿微量白蛋白/肌酐比值（UACR）与臂踝脉搏波传导速度（baPWV）的相关性,同时探讨其他可能影响baPWV的因素。方法 800例住院的2型糖尿病患者,行baPWV、UACR、血脂、肾功能、空腹血糖、空腹C肽、糖化血红蛋白、血钙磷、血甲状旁腺激素等测定。采用单因素方差分析及多元线性逐步回归分析评价baPWV与UACR及其他各因素相关情况。结果 2型糖尿病患者随着年龄增大,baPWV逐渐增大（P<0.001）。按UACR不同水平分为3组后,＞300 mg/g组baPWV（1958.10±530.76 cm/s）较＜30 mg/g组（1609.86±310.98 cm/s）、30～300 mg/g组（1659.88±354.27 cm/s）显著增大（均P<0.005）。Pearson相关分析显示,baPWV与年龄、收缩压、脉压差、血清尿素氮及UACR呈正相关（r＝0.554、0.393、0.440、0.158、0.300,均P<0.05）,与血清白蛋白、肾小球滤过率、血磷、钙磷乘积呈负相关（r＝－0.195、－0.261、－0.203、－0.176,均P<0.05）。多元逐步线性回归分析显示,baPWV与年龄、收缩压、UACR呈独立正相关（β＝0.488、0.266、0.143,t＝14.55、8.12、4.47,均P<0.001）,与血磷呈独立负相关（β＝－0.083,t＝－2.57,P<0.05）。结论 2型糖尿病患者baPWV与年龄、收缩压、UACR及血磷独立相关。     

Analysis of the correlation between baseline serum uric acid,urinary albumin/creatinine ratio and cognitive impairment in elderly patients with type 2 diabetes mellitus

<正>Objective To assess the impact of baseline serum uric acid(SUA) and urinary albumin/creatinine ratio(UACR) on cognitive impairment in elderly patients with type 2 diabetes mellitus(T2DM).Methods This prospective cohort study included 1 071 type 2 diabetes mellitus(T2DM) patients who were regularly followed up in Lee’s clinic.Patients were regularly followed up annually with an average of 5 years.The group was divided into cognitive impairment group(CI,n=173)and no significant cognitive ...     

2型糖尿病患者尿白蛋白/肌酐比值与糖尿病视网膜病变关系的研究

目的 探讨2型糖尿病患者尿白蛋白/肌酐比值(UACR)与糖尿病视网膜病变(DR)的关系.方法 595例2型糖尿病患者进行UACR和眼底摄片检查,并根据UACR将患者分为3组:正常白蛋白尿组(n =519)、微量白蛋白尿组(n=28)和大量白蛋白尿组(n=48).比较3组患者的年龄、糖尿病病程等基本情况及DR发生率;同时以正常白蛋白尿组为参照,分析另外两组患者DR的相对危险度;最后,运用多元逐步线性回归和二元Logistic回归验证UACR与DR发生率的关系.结果 (1)3组患者的年龄、糖尿病病程、腰臀比、收缩压、舒张压、UACR差异有统计学意义(P＜0.05).(2)3组患者DR发生率依次升高,分别为30.4％、53.6％、54.2％,且差异有统计学意义(P＜0.001).(3)微量白蛋白尿组患DR的相对危险度为2.638 (95％ CI:1.225 ～ 5.682),大量白蛋白尿组患DR的相对危险度为2.702(95％ CI:1.486 ～4.902),且差异均存在统计学意义(P＜0.05).(4)多元逐步线性回归和二元Logistic回归显示,UACR与DR发生率有着显著的联系(P＜0.05).结论 2型糖尿病患者UACR与DR的发生密切相关.     

Low muscular mass and overestimation of microalbuminuria by urinary albumin/creatinine ratio

Microalbuminuria is a mild urinary albumin elevation and is associated with cardiovascular disease. Urinary albumin/creatinine ratio is recommended for microalbuminuria assessment, because it reflects urinary albumin excretion. Muscular mass could affect albumin/creatinine ratio, because urinary creatinine reflects muscular mass. The study investigated high albumin/creatinine ratio attributed to low urinary creatinine without microalbuminuria. The Gubbio Population Study for ages 45 to 64 collected data on weight, skinfold, urinary albumin, urinary creatinine, and coronary heart disease. Weight and skinfold thickness were used to calculate fat and nonfat mass and urinary creatinine as a marker of muscular mass. Microalbuminuria was defined as urinary albumin of 20 to 199 microg/min and high albumin/creatinine ratio as a ratio of 17 to 250 microg/mg in men and of 25 to 355 microg/mg in women. Persons with macroalbuminuria (urinary albumin > or =200 microg/min) were excluded to focus analyses on microalbuminuria. Coronary heart disease was defined by ECG and questionnaire. The target cohort consisted of 1623 men and women, ages 45 to 64. Prevalence was 8.5% for high albumin/creatinine ratio (n=138), 4.3% for microalbuminuria (n=69), 5.2% for high albumin/creatinine ratio without microalbuminuria (n=85), and 1.0% for nonhigh albumin/creatinine ratio with microalbuminuria (n=16). High albumin/creatinine ratio without microalbuminuria was inversely associated with nonfat mass and urinary creatinine (P<0.04). Compared with persons with a nonhigh albumin/creatinine ratio, coronary heart disease was more prevalent in persons with a high albumin/creatinine ratio and microalbuminuria (18.9% and 7.1%; P=0.002), not in persons with a high albumin/creatinine ratio without microalbuminuria (8.2% and 7.1%; P=0.706). A high albumin/creatinine ratio in persons with low muscle mass indicates low urinary creatinine more often than microalbuminuria and cardiovascular disease.     

Assessing urinary levels of IL-18, NGAL and albumin creatinine ratio in patients with diabetic nephropathy

AimsDiabetic nephropathy (DN) is a serious microvascular complication of a longstanding hyperglycemia. This study aims to evaluate whether urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary Interleukin-18 possess a better diagnostic value than albumin creatinine ratio in assessing the severity of nephropathy in patients with type 2 diabetes mellitus (T2DM).Material & methodsNinety participants diagnosed with T2DM were recruited and they were divided into three study groups according to their albumin/creatinine ratio (ACR): (Normoalbuminuria group, Microalbuminuria group, and Macroalbuminuria group). A matching of Ninety healthy subjects were included as controls. Blood and urine samples were collected to measure various markers of glycemic control and kidney function.ResultsIL-18 levels were not changed significantly between all study groups (P > 0.05), despite a significant positive correlation between IL-18 and urinary albumin levels.NGAL levels were significantly increased in Microalbuminuria group and Macroalbuminuria group as compared to the control and Normoalbuminuria groups. NGAL was also positively correlated with urinary albumin and ACR, but negatively correlated with the age and body mass index. Receiver Operating Characteristic curves revealed that for early detection of DN, the best cutoff values to discriminate DN and diabetic without nephropathy groups were ˃ 21.4 ng/ml for NGAL (94.67 sensitivity, 26.67% specificity), ≤0.34 pg/mL for IL-18 (72% sensitivity, 53.33% specificity), and ˃29.8 mg/g for ACR (80% sensitivity, 100% specificity).ConclusionWe conclude that the urinary ACR is a more accurate individual biomarker of DN when compared to both NGAL and IL-18.     

Study on the correlation between continuous glucose monitoring indexes and urinary albumin/creatinine ratio in asymptomatic hypoglycemia patients with type 2 diabetes mellitus

<正>Objective To explore the correlation between continuous glucose monitoring indicators time within glucose target range(TIR),time glucose below target range(TBR) and urinary albumin/creatinine ratio(UACR) in type 2 diabetes mellitus(T2DM) patients with asymptomatic hypoglycemia.     

高血压与2型糖尿病患者尿白蛋白/肌酐比值关系的临床研究

目的 分析BP与T2DM患者尿白蛋白/肌酐（UACR）的关系,探讨BP对糖尿病慢性肾脏疾病（CKD）的影响. 方法 收集330例T2DM患者资料,测BP和UACR.根据UACR水平分为＜30mg/24 h组、30～299mg/24 h组和≥300mg/24 h组,检测各组BP及UACR等水平的变化情况.结果 正常血压组及高血压组蛋白尿发生率为31.4％及64.2％.病程＜10年、病程10～20年及病程＞20年正常血压者与高血压者比较,总蛋白尿的发生率分别为0％、8％,7.6％、30.1％,0％及51.7％（P＜0.01）.UACR＜30 mg/24 h组、≥300mg/24 h组高血压发生率为30.3％及69.1％;病程＜10年、病程10～20年及病程＞20年患者中＜30mg/24 h组、30～299mg/24 h组和≥300mg/24 h组比较,高血压发生率分别为28.9％、67.4％、100％,33.3％、50.9％、76.7％,25.0％、84.6％和100％ （P＜0.01）. 结论 高血压加速CKD的发生.     

认知障碍患者认知功能与泪液分泌的相关性

目的 探讨认知障碍患者认知功能与泪液分泌的相关性。方法 选择2021年6月至2022年6月解放军总医院第六医学中心神经内科收治的213例患者为研究对象,其中阿尔茨海默病(AD)组71例、轻度认知功能障碍(MCI)组75例、对照组67例。应用简易智能状态检查量表(MMSE)与蒙特利尔认知评估量表(MoCA)评估认知功能,Schirmer试验检测泪液分泌情况。采用 SPSS 25.0统计软件进行数据分析。根据数据类型,分别采用单因素方差分析、Kruskal-Wallis 秩和检验或χ²检验进行组间比较。应用Pearson相关和Spearman秩相关分析Schirmer试验结果与MMSE和MoCA评分的相关性。构建受试者工作特征(ROC)曲线,评价Schirmer试验结果对认知障碍的预测价值。结果 AD组与MCI组患者泪液分泌水平均低于对照组,差异有统计学意义(P＜0.01);AD组与MCI组泪液分泌差异无统计学意义(P＞0.05)。相关分析显示,Schirmer试验结果与MMSE评分、MoCA评分呈正相关(r=0.304,0.391;P＜0.001),并与MoCA的各分项得分呈正相关(P＜0.05)。Schirmer试验诊断AD及MCI的ROC曲线下面积(AUC)分别为0.818(P＜0.001)和0.753(P＜0.001)。结论 认知障碍患者泪液分泌减少,其认知功能与泪液分泌具有相关性。     

Study on the correlation between the volume ratio of extracellular fluid to intracellular fluid and urinary albumin creatinine ratio in type 2 diabetes mellitus patients

<正>Objective To explore the correlation between the volume ratio of extracellular fluid and intracellular fluid(ECW/ICW) and urinary albumin creatinine ratio(UACR) in type 2 diabetes mellitus(T2DM) patients.Methods 322 T2DM patients hospitalized in the Department of Endocrinology,Tangdu Hospital,Air Force Military Medical University from May 2021 to April2022 were divided into normal proteinuria group(Con,UACR <30 mg/g,n=175),microalbuminuria group(Mic,30≤UACR≤300 mg/g,n=78) and massive...