低度白蛋白尿与颈动脉内中膜厚度相关性研究

Association of low-grade albuminuria with carotid intima-media thickness

目的探讨低度白蛋白尿与颈动脉内中膜厚度（ Carotid intima-media thickness, CIMT）的相关性。方法选取上海市嘉定区40岁及以上常住居民进行了问卷调查、体格检查、血尿生化检测以及CIMT的测量,对数据完整的9523人进行分析；尿白蛋白/肌酐比值（ Urinary albumin to creatinine ratio, UACR）≥本研究人群性别特异性上四分位定义为低度白蛋白尿,CIMT≥本研究人群上十分之一定义为CIMT增厚；采用多元logistic回归方程探讨两者相关性。结果本研究人群CIMT增厚的患病率为21.44%,CIMT增厚患者UACR水平显著高于非CIMT增厚者（4.79对4.51 mg/g,P＆lt;0.01）；随着UACR四分位水平的增加CIMT增厚的患病率依次升高,从第1到第4四分位的患病率分别为18.99%、19.24%、20.20%和27.33%（ P趋势＆lt;0.01）。校正了传统心血管危险因素后,多元logistic回归分析结果显示,与UACR第1四分位相比,第4四分位患CIMT增厚的风险将增加25%。结论独立于其他传统心血管危险因素,低度白蛋白尿是CIMT增厚的危险因素。

Objective To analyze the association of elevated carotid intima-media thickness（CIMT）with low-grade albuminuria in a community-based population. Methods A total of 10 375 participants aged 40 years or older were recruited using cluster sampling from Jiading district, Shanghai. Standardized questionnaires were adopted to collect information on health status and lifestyles. Anthropometric measurements including weight, height, and blood pressure, and biochemical tests for blood and urine were performed. CIMT was detected by B-mode ultrasound examinations. 9 523 subjects were included for final analysis. All these subjects were divided into 4 groups according to sex-specific urinary albumin to creatinine ratio （ UACR ） quartiles. CIMT≥upper decile of the population was defined as elevated CIMT and low-grade albuminuria was defined as UACR≥sex-specific upper quartile. The relationship between UACR and CIMT was investigated by multiple logistic regression analysis. Results The prevalence of elevated CIMT in this population aged 40 years or older with albuminuria in normal range was 21. 44%. Comparing to participants without elevated CIMT, those with elevated CIMT showed higher level of UACR （4. 79 vs 4. 51 mg/g, P〈0. 01）. The metabolic status was deteriorated with the increment of UACR level. The prevalences of elevated CIMT were 18. 99%, 19. 24%, 20. 20%, and 27. 33% from the lowest to highest UACR quartile, respectively（Ptrend〈0. 01）. After adjusting for some conventional cardiovascular risk factors, multiple logistic regression revealed that compared with the participants in the lowest quartile of UACR, those in the highest quartile had a 1. 25-fold risk of elevated CIMT. Conclusions This study shows that low-grade albuminuria is positively associated with elevated CIMT, independent of conventional cardiovascular risk factors in middle-aged and elderly adults.