某医院体检人群中尿微量白蛋白/肌酐比值检测情况分析

Analysis of test results for determining urine albumin-to-creatinine ratio among health examination population in a hospital

目的 了解体检人群尿微量白蛋白/肌酐比值（albumin-to-creatinine ratio,ACR）阳性率情况,分析尿微量白蛋白/肌酐比值的影响因素.方法 670名完成尿ACR检测的健康体检者,根据肾脏病预后质量倡议指南（K/DOQI）推荐的ACR水平分为2组：ACR阳性组（男性：ACR≥17 mg/g;女性：ACR≥25 mg/g）,正常组（男性：ACR〈17 mg/g;女性：ACR〈25 mg/g）.采用单因素和多因素Logistic回归模型评估年龄、性别、超重或肥胖、高血压、糖代谢紊乱（高血糖）、高三酰甘油血症、高胆固醇血症、高低密度脂蛋白血症、低高密度脂蛋白血症及高尿酸血症等对ACR结果的影响程度.结果 670名健康体检人群中ACR阳性54名,发生率8.1％.正常组与ACR阳性组间,年龄、体质指数、腰围身高比、收缩压、舒张压、血糖、尿酸组间比较差异具有统计学意义[年龄（47.6±11.3）岁比（53.8±11.9）岁,t=-3.858,P〈0.01;体质指数（24.1±3.1）kg/m2比（24.9±3.5）kg/m2,t=-1.982,P〈0.05;腰围身高比0.5±0.5比0.5±0.1,Z=-2.146,P〈0.05;收缩压（115.3±15.6）mmHg（1mmHg=0.133 kPa）比（130.9±23.7）mmHg,t=-4.755,P〈0.01;舒张压（72.3±9.2）mmHg比（80.0±9.8）mmHg,t=-5.897,P〈0.01;血糖（4.6±1.2）mmol/L比（5.6±2.8）mmol/L,t=-2.466,P〈0.01;尿酸（362.99±92.80）μmol/L比（397.7±95.6）μmol/L,t=-2.633,P〈0.01].三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇组间比较差异无统计学意义（P〉0.05）.应用单因素Logistic回归模型进行评估,年龄、高血压、糖代谢紊乱、高密度脂蛋白胆固醇降低是影响ACR结果的影响因素.在多因素Logistic回归模型中,与ACR比较差异有统计学意义的变量包括：高血压（OR：2.843,95％CI：1.472～5.493,P〈0.01）、糖代谢紊乱（OR：2.132,95％CI：1.042～4.365,P〈0.05）.随着危险因素的聚集,ACR阳性率显著上升,与基线时不具有危险因素者相比,具有4个及以上危险因素者其OR值达18.281.结论 高血压及糖代谢紊乱是影响ACR阳性率的重要因素,而随着危险因素聚集个数增加,ACR阳性检出率亦明显上升.

Objective To investigate the prevalence of high urine albumin-to-creatinine ratio （ACR） among health check up population and evaluate the potential predictors for ACR. Methods A cross-sectional study was conducted among health check up population in the Zhongshan Hospital during 2015. Potential participants completed urine ACR test,body mass index （BMI） and blood test. ACR level was divided into two groups according to the K/DOQI recommendation：ACR Group（male：ACR≥17 mg/g;female：≥25 mg/g）, Normal Group （male：ACR〈17 mg/g;female：ACR〈25 mg/g）. Univariate and multivariate logistic regression models were performed to evaluate the associations of ACR with potential predictors （including age,sex,over-weight or obesity,hypertension,glucose metabolism disorders, hypertriglyceridemia,hypercholesterolemia,high low HDL-C and hyperuricemia）. Result Totally 670 people from the health check up population were screened for ACR test, 54 cases were positive, the prevalence was 8.1%. Age, BMI, waist-to-height ratio, SBP, DBP, blood sugar and uric acid had statistical significance between Normal group and ACR group[Age 47.62 ± 11.29 vs. 53.83 ± 11.93, t=-3.858, P〈0.01;BMI （24.05±3.12） kg/m2 vs. （24.94±3.49） kg/m2, t=-1.982, P〈0.05;waist-to-height ratio 0.51±0.52 vs. 0.53 ± 0.06, Z=-2.146, P〈0.05; SBP （mmHg, 1 mmHg=0.133 kPa） 115.31 ± 15.59 vs. 130.91 ± 23.66, t=-4.755, P〈0.01;DBP（mmHg） 72.31 ± 9.16 vs. 80.02 ± 9.81, t=-5.897,P〈0.01;blood sugar （mmol/L） 4.64 ± 1.20 vs. 5.57 ± 2.77, t=-2.466, P〈0.01;uric acid （μmol/L） 362.99 ± 92.80 vs. 397.76 ± 95.62, t=-2.633, P〈0.01]. Age, hypertension, glucose metabolism, HDL reduction were risk factors for urinary albumin/creatinine ratio. In the multivariate logistic regression model, hypertension status was found to be associated with ACR positive [odd ratio （OR）： 2.843, 95% confidence interval [CI, 1.472-5.493, P〈0.01], glucose metabolism disorders （OR, 2.132, 95%CI, 1.042-4.365, P〈0.05）. As the number of risk factors increases, the rate of positive of ACR showed marked increase, comparing persons with no risk factors to those with four or more risk factors , the OR value rose up to 18.281. Conclusion Hypertension and glucose metabolism disorder are risk factors of chronic renal dysfunction. With the increase of risk factors, the rate of positive of ACR was higher. ACR test is recommended routine screening for people over the age of 50.