尿微量白蛋白/肌酐在老年健康体检人群慢性肾脏病筛查中的应用

Application of urine microalbumin/creatinine in screening chronic kidney disease in the elderly

目的探讨尿微量白蛋白/肌酐(ACR)在老年健康体检人群慢性肾脏病(CKD)筛查中的应用。方法随机选择2016年3月至2019年6月在南京医科大学第二附属医院健康管理中心行ACR检查的1029名老年健康体检人员,以ACR检测结果分为2组ACR≥30 mg/g为ACR+组,ACR<30 mg/g为ACR-组,比较2组一般临床特征和实验室参数,并采用Logistic回归,分析ACR+的影响因素。结果老年健康体检者中ACR+检出率为21.67%,ACR+者BMI、FPG、SBP、血UA、TG显著高于ACR-者;研究对象大部分位于CKD3期及之前,ACR+与CKD分期呈正相关(χ^(2)=10.183,P=0.017)。多因素Logistic回归分析显示年龄(OR=1.761,95%CI1.406~2.205)、BMI(OR=1.479,95%CI1.237~1.767)、高血压(OR=1.228,95%CI1.228~1.872)、FPG(OR=1.913,95%CI 1.544~2.371)与ACR+有关。结论高血糖、高血压、高BMI为老年人蛋白尿独立危险因素,此类人群在健康体检中选择ACR检测,有利于CKD的早期发现。

Objective To investigate the application of urinary microalbumin/creatinine(ACR)in screening chronic kidney disease(CKD)in the elderly.Methods A total of 1029 elderly who underwent ACR examination in the health management center of the Second Affiliated Hospital of Nanjing Medical University from March 2016 to June 2019 were randomly selected and divided into two groups ACR+group with ACR≥30 mg/g and ACR-group with ACR<30 mg/g.The general clinical characteristics and laboratory parameters of the two groups were compared.The clinical data were stratified and assigned into Logistic regression equation to analyze the influencing factors of ACR+.Results The detection rate of ACR+was 21.67%in the elderly undergoing physical examination.The levels of body mass index(BMI),fasting plasma glucose(FPG),systolic blood pressure,blood uric acid and triglyceride(TG)of ACR+patients were significantly higher than those of ACR-patients.Most of the subjects were in the stage before CKD 3 stage,and ACR+was positively correlated with CKD stage.Multivariate Logistic regression analysis showed that age(OR=1.761,95%CI 1.406-2.205),BMI(OR=1.479,95%CI 1.237-1.767),hypertension(OR=1.228,95%CI 1.228-1.872),FPG blood glucose(OR=1.913,95%CI 1.544-2.371)were positively correlated with ACR+.Conclusions High blood glucose,hypertension and high BMI are independent risk factors of proteinuria in the elderly.ACR detection is helpful for early detection of CKD in these people.