糖尿病患者尿白蛋白与肌酐比值与肾动态显像肾小球滤过率的相关性研究

The relationship between urinary albumin to creatinine ratio and glomerular filtration rate measured by ^(99m)TC-DTPA renal scintigraphy in diabetic patients

目的探讨尿白蛋白与肌酐比值(UACR)和肾小球滤过率(GFR)联合诊断在糖尿病肾脏病变评估中的临床意义。方法分析294例住院糖尿病患者的资料,行^(99m)TC-DTPA肾小球滤过率和UACR检查。结果正常白蛋白尿、微量白蛋白尿及大量白蛋白尿患者中分别有9.6%(15/157)、25.3%(23/91)、45.7%(21/46)出现了GFR的下降;以UACR为标准诊断糖尿病患者肾损害的灵敏度、特异度分别为88.9%、59.3%,以GFR为标准其灵敏度、特异度分别为80.6%、88.8%,而联合UACR与GFR诊断其灵敏度、特异度分别为94.4%、54.3%;结论UACR正常的糖尿病患者已有部分出现肾功能下降,联合GFR有助于更好地评价糖尿病患者的肾脏病变情况。

Objective To investigate the relationship between urinary albumin to creatinine ratio （UACR） and glomerular filtration rate （GFR） in diabetic chronic kidney disease. Methods A total of 294 diabetic patients were enrolled. The glomerular filtration rate was measured by 99mTC-DTPA renal scintigraphy. We measured urine albumin and creatinine, and calculated UACR and then analyzed the relation between UACR and GFR. Results （1） There were 59 patients who had low GFR[GFR〈60 ml · minn^-1（1.73m）-2],including 15 patients （9.6%） with norrnoalbuminuria , 23 patients （25.3%） with microalbuminuria and 21 patients （45.7%） with macroalbuminuria. （2） The sensitivity and specificity in patients diagnosed as chronic kidney disease were 88. 9% and 59.3% based on only UACR, were 94. 4% and 54. 3% based on combination of UACR and GFR, and were 81% and 89% based on only GFR, respectively. Conclusion A considerable proportion in diabetic patients without albuminuria may have renal impairment. The combination of UACR and GFR may enhance the capability of diagnosis of chronic kidney disease.