人体测量学肥胖判定指标与微量白蛋白尿的相关性

Correlation between anthropometric obesity index and microalbuminuria

目的:探讨各项人体测量学肥胖判定指标与微量白蛋白尿(MAU)的相关性。方法:采取分层的整群随机抽样方法,从糖尿病流行病学调查数据库中抽取1 170例,清晨留取随机测定尿微量白蛋白和尿肌酐,根据尿微量白蛋白/尿肌酐比值(UACR)水平分为:正常白蛋白尿(NAU)组(男398例,女409例)和MAU组(男175例,女188例)。收集一般临床资料和测定生化指标,统计学处理采用SPSS 16.0软件。结果:与NAU组相比,MAU组年龄、空腹血糖(FBG)、舒张压(DBP)、收缩压(SBP)、血清尿酸(SUA)、腰围(WC)、腰身比(WHtR)、腰臀比(WHR)、高血糖(HG)、原发性高血压、血脂异常及肥胖,尤其腹型肥胖患病率均高于前者,差异有统计学意义;多元线性回归分析,年龄、DBP、FBG、WHtR、WC、WHR与UACR相关。调整年龄、性别、FBG及DBP等因素后,对MAU影响大小依次WHtR>WC>WHR;采用受试者工作特征曲线(ROC)分析男性人群WHtR、WC、WHR等预测MAU的曲线下面积依次为0.68(95%CI:0.67-0.70)、0.64(95%CI:0.62-0.65)、0.57(95%CI:0.55-0.59),预测切点0.52、91.8、0.90cm。在女性人群中,WHtR、WC、WHR等预测MAU的曲线下面积依次为0.71(95%CI:0.70-0.72)、0.69(95%CI:0.68-0.70)和0.64(95%CI:0.62~0.65),预测切点0.52、82.5、0.84 cm。结论:人体测量学腹型肥胖指标与微量白蛋白尿密切相关,可作为预测、评估人群患病风险的简易指标;在人体测量学腹型肥胖指标中,WHtR是预测本地区人群微量白蛋白尿等风险的最好指标,最佳切割点为0.52。

Objective： To investigate the correlation between the anthropometric obesity index and microalbuminuria（MAU）. Methods： A stratified cluster random sampling method was adopted to investigate the epidemiology of diabetes in Chengyang District of Qingdao city in 2012. Totally 1170 cases were collected from the epidemiological survey database of Chengyang District in 2012. The urinary albumin and urinary creatinine were randomly determined in the early morning. According to the ratio of the two UACR levels were divided into normal albumin urine （NAU） group （398 males, 409 females） and microalbuminuria（MAU） group（175 males, 188 females）. The clinical data and biochemical indexes of the subjects were collected and were statistically analyzed by SPSS 16.0 software. Results： Age, FBG, DBP, SBP, SUA, WC, WHtR, WHR, high blood glucose, hypertension, dyslipidemia and obesity especially abdominal obesity prevalence rate were higher in the MAU group than that of the NAU group, and the difference was statistically significant. Multiple linear regression analysis with UACR as the dependent variable showed that age, DBP, FBG, WHtR, WC and WHR were associated with UACR. After adjusting age, sex, FBG and DBP, the contribution to MAU was in turns as WHtR〉WC〉WHR. The receiver operating characteristic curve analysis showed that in male population, the area under the curve of WHtR, WC, WHR to predictive MAU was 0. 68 （95% CI： 0.67-0.70）, 0.64 （95% CI： 0.62-0.65）, 0.57 （95% CI： 0.55-0. 59）, respectively, while the predictive point was 0. 52, 91.8, 0.90 cm. In female population, the area under the curve of WHtR, WC, WHR to predictive MAU was 0.71（95% CI： 0.70 0.72）, 0.69（95% CI： 0.68-0.70） and 0. 64（95% CI： 0. 62-0. 65） , respectively, and the predictive point was 0.52, 82.5, 0.84 cm. Conclusion： Anthropometry of abdominal obesity index is intimately related with and may predict and evaluate the risk of MAU. Compared with other anthropometric indicators, WHtR may be the best index for predicting cardiovascular risk factors in Qingdao area, and the best WHtR cut-point is 0.52.