中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2009年
10期
1091-1095
,共5页
郭玮%吴炯%唐文佳%朱文欣%潘柏申
郭瑋%吳炯%唐文佳%硃文訢%潘柏申
곽위%오형%당문가%주문흔%반백신
糖尿病肾病%白蛋白尿%白蛋白类%尿分析%肌酸酐
糖尿病腎病%白蛋白尿%白蛋白類%尿分析%肌痠酐
당뇨병신병%백단백뇨%백단백류%뇨분석%기산항
Diabetic nephropathies%Albuminuria%Albumins%Urinalysis%Creatinine
目的 研究糖尿病患者不同时段尿白蛋白(urinary albumin)的排泌情况及尿白蛋白在诊断早期糖尿病肾脏损伤中的应用.方法 收集中山医院门诊及住院糖尿病患者及健康对照组3 d内不同时间段的尿液,分析尿白蛋白天内、天间的排泌变化情况;以24 h尿白蛋白为标准判断肾脏早期损伤情况,比较不同时段尿及时间点尿与24 h尿白蛋白的相关性、诊断特异度及敏感度;评估随机尿的诊断特异度及敏感度,推导随机尿最佳诊断水平.结果尿白蛋白天间变异较大,以尿Cr和尿量分别校正后可降低变异.糖尿病组中尿白蛋白使用尿Cr校正后变异系数(CV)小于尿量校正(CV分别为49%±23%vs 64%±30%).尿白蛋白天内排泌呈节律性变化.不同尿液留取方式中夜间尿尿白蛋白/尿Cr(ratio of urinary concentrations of albumin and creatinine,ACR)与24 h尿白蛋白定量相关性最好(R~2=0.976),优于晨尿ACR(R~2=0.900)、午间餐后尿ACR(R~2=0.584)和随机尿ACR(R2=0.791).以24 h尿白蛋白总量作为判断标准进行受试者操作特性曲线(ROC曲线)分析显示,随机尿ACR的判断值为27.7 μg/mg尿Cr(存在男女性别差异:男性12.8μg/mg尿Cr vs性27.0μg/mg尿Cr).最小阴性似然比0.011时推导随机尿ACR的排除判断值为13.0 μg/mg尿Cr;最大阳性似然比481.000时推导随机尿ACR的确诊判断值为87.4 μg/mg尿Cr.结论 尿Cr较尿量能更好地降低尿白蛋白天内变异,但仍无法完全消除变异.夜尿ACR与24 h尿白蛋白定量相关性最好,可替代24 h尿白蛋白定量.随机尿ACR作为最方便留取的尿液标本亦可以较好地替代24 h尿白蛋白定量,但应考虑引入尿Cr后带来的性别间差异.以13.0 μg/mg及87.4 μg/mg作为随机尿ACR的排除判断值及确诊判断值可以便于临床医师基本排除或确定白蛋白尿的出现.
目的 研究糖尿病患者不同時段尿白蛋白(urinary albumin)的排泌情況及尿白蛋白在診斷早期糖尿病腎髒損傷中的應用.方法 收集中山醫院門診及住院糖尿病患者及健康對照組3 d內不同時間段的尿液,分析尿白蛋白天內、天間的排泌變化情況;以24 h尿白蛋白為標準判斷腎髒早期損傷情況,比較不同時段尿及時間點尿與24 h尿白蛋白的相關性、診斷特異度及敏感度;評估隨機尿的診斷特異度及敏感度,推導隨機尿最佳診斷水平.結果尿白蛋白天間變異較大,以尿Cr和尿量分彆校正後可降低變異.糖尿病組中尿白蛋白使用尿Cr校正後變異繫數(CV)小于尿量校正(CV分彆為49%±23%vs 64%±30%).尿白蛋白天內排泌呈節律性變化.不同尿液留取方式中夜間尿尿白蛋白/尿Cr(ratio of urinary concentrations of albumin and creatinine,ACR)與24 h尿白蛋白定量相關性最好(R~2=0.976),優于晨尿ACR(R~2=0.900)、午間餐後尿ACR(R~2=0.584)和隨機尿ACR(R2=0.791).以24 h尿白蛋白總量作為判斷標準進行受試者操作特性麯線(ROC麯線)分析顯示,隨機尿ACR的判斷值為27.7 μg/mg尿Cr(存在男女性彆差異:男性12.8μg/mg尿Cr vs性27.0μg/mg尿Cr).最小陰性似然比0.011時推導隨機尿ACR的排除判斷值為13.0 μg/mg尿Cr;最大暘性似然比481.000時推導隨機尿ACR的確診判斷值為87.4 μg/mg尿Cr.結論 尿Cr較尿量能更好地降低尿白蛋白天內變異,但仍無法完全消除變異.夜尿ACR與24 h尿白蛋白定量相關性最好,可替代24 h尿白蛋白定量.隨機尿ACR作為最方便留取的尿液標本亦可以較好地替代24 h尿白蛋白定量,但應攷慮引入尿Cr後帶來的性彆間差異.以13.0 μg/mg及87.4 μg/mg作為隨機尿ACR的排除判斷值及確診判斷值可以便于臨床醫師基本排除或確定白蛋白尿的齣現.
목적 연구당뇨병환자불동시단뇨백단백(urinary albumin)적배비정황급뇨백단백재진단조기당뇨병신장손상중적응용.방법 수집중산의원문진급주원당뇨병환자급건강대조조3 d내불동시간단적뇨액,분석뇨백단백천내、천간적배비변화정황;이24 h뇨백단백위표준판단신장조기손상정황,비교불동시단뇨급시간점뇨여24 h뇨백단백적상관성、진단특이도급민감도;평고수궤뇨적진단특이도급민감도,추도수궤뇨최가진단수평.결과뇨백단백천간변이교대,이뇨Cr화뇨량분별교정후가강저변이.당뇨병조중뇨백단백사용뇨Cr교정후변이계수(CV)소우뇨량교정(CV분별위49%±23%vs 64%±30%).뇨백단백천내배비정절률성변화.불동뇨액류취방식중야간뇨뇨백단백/뇨Cr(ratio of urinary concentrations of albumin and creatinine,ACR)여24 h뇨백단백정량상관성최호(R~2=0.976),우우신뇨ACR(R~2=0.900)、오간찬후뇨ACR(R~2=0.584)화수궤뇨ACR(R2=0.791).이24 h뇨백단백총량작위판단표준진행수시자조작특성곡선(ROC곡선)분석현시,수궤뇨ACR적판단치위27.7 μg/mg뇨Cr(존재남녀성별차이:남성12.8μg/mg뇨Cr vs성27.0μg/mg뇨Cr).최소음성사연비0.011시추도수궤뇨ACR적배제판단치위13.0 μg/mg뇨Cr;최대양성사연비481.000시추도수궤뇨ACR적학진판단치위87.4 μg/mg뇨Cr.결론 뇨Cr교뇨량능경호지강저뇨백단백천내변이,단잉무법완전소제변이.야뇨ACR여24 h뇨백단백정량상관성최호,가체대24 h뇨백단백정량.수궤뇨ACR작위최방편류취적뇨액표본역가이교호지체대24 h뇨백단백정량,단응고필인입뇨Cr후대래적성별간차이.이13.0 μg/mg급87.4 μg/mg작위수궤뇨ACR적배제판단치급학진판단치가이편우림상의사기본배제혹학정백단백뇨적출현.
Objective To investigate the urinary albumin excretion of the diabetes patients and application value in the monitoring of early impairment in kidney. Methods The random urine samples from diabetes patients and controls within three days were collectod. The changes of urinary albumin excretion within day and between days were analyzed. 24-hour urine albumin was used as a standard to evaluate early kidney damage. The correlations between results of random urine albumin at the different time points and different periods were comparod. The sensitivity and specificity of random urine albumin at the different time points and different periods was evaluated and compared to deduce the best diagnostic porformance of the random urine albumin. Results There are greater variations of the levels of urinary albumin of patients with diabetes and control. After the correction with urine creatinine and urine volume the variations can be reduced (CV:49%±23% and 64%±30%). Urinary albumin excretion rate change rhythmically within the 24 h in healthy and diabetes patients. We found the best correlation between overnight ratio of urinary concentrations of albumin and creatinine (ACR) and 24-hour urinary albumin (R2 = 0.976). It was superior to urina sanguinis (R~2 = 0.900), postprandial urine (R~2 = 0.584) and random urine (R~2 =0.791). When 24 h urinary albumin was taken as the standard, receiver operating characteristic (ROC) curve analysis showed there was significant difference between male and female(male 12.8 μg/mg urine creatinine vs female 27.0 μg/mg urine creatinine),and the the cut-off value of ACR was 27.7μg/mg urine creatinine. When the smallest available negative likelihood ratio (0.011) and the greatest positive likelihood ratio (481.000) were obtained,the concentration of 13.0 μg/mg creatinine and 87.4 μg/mg creatinine were set as the cut-off value of ACR. Conclusions The correction with urinary creatinine can reduce the variation between-days compared with urine volume, but still can not completely eliminate the variability. The ACR of overnight urine has the best correlation with the 24 h urinary albumin and can replace 24 h urinary albumin. Random urine as the most convenient collecting urine samples can also replace 24-hour urinary albumin, but the gender discrepancy need to be considered. When the concentration of 13.0 μg/mg and 87.4 μg/mg was set as a random ACR exclusion value and the confirmative value, it can basically rule out and confirm the existence of microalbuminuria.
