CAJ | 학술논문

目的：研究2型糖尿病患者不同时间点尿白蛋白/肌酐比值（ACR）与24 h 尿白蛋白（24 h UA）的相关性，探讨采用不同时间点尿ACR替代24 h UA 用于2型糖尿病早期肾损伤筛查的应用价值。方法：收集89例住院2型糖尿病患者24 h 尿及不同时间点尿（主要是晨尿和随机尿）标本，比较不同时间点尿ACR 与24 h UA 的相关性、诊断敏感度及特异度；同时以24 h UA 为标准，建立不同时间点尿 ACR 的 ROC曲线，并比较ROC 曲线下面积。结果：不同尿液留取方式中晨尿及随机尿 ACR 分别为9．02（5．69～11．64） mg/mmol及8．65（5．80～11．83）mg/mmol，组间比较差异无统计学意义（Z＝1．107，P＞0．05）。随机尿ACR与晨尿ACR相关分析显示两者呈高度相关（r＝0．951，P＜0．01）；晨尿ACR、随机尿ACR与24 h UA均具有高度相关性，r 分别为0．886及0．859（P＜0．01）；晨尿 ACR 诊断白蛋白尿的敏感度及特异度分别为92．6％及87．5％，随机尿 ACR 分别为90．1％及87．5％，两者相近。以24 h UA 作为判断标准，进行 ROC 曲线分析显示，晨尿、随机尿 ACR 的ROC 曲线下面积分别为（0．954±0．022）及（0．960±0．021），组间比较差异无统计学意义（Z＝1．107，P＞0．05）。结论：晨尿及随机尿 ACR 与24 h UA 均具有较好的相关性，均可替代24 h UA。但因随机尿ACR 更方便留取尿液标本，可以较好地替代24 h UA 作为2型糖尿病早期肾损伤的筛查及监测指标。
목적：연구2형당뇨병환자불동시간점뇨백단백/기항비치（ACR）여24 h 뇨백단백（24 h UA）적상관성，탐토채용불동시간점뇨ACR체대24 h UA 용우2형당뇨병조기신손상사사적응용개치。방법：수집89례주원2형당뇨병환자24 h 뇨급불동시간점뇨（주요시신뇨화수궤뇨）표본，비교불동시간점뇨ACR 여24 h UA 적상관성、진단민감도급특이도；동시이24 h UA 위표준，건립불동시간점뇨 ACR 적 ROC곡선，병비교ROC 곡선하면적。결과：불동뇨액류취방식중신뇨급수궤뇨 ACR 분별위9．02（5．69～11．64） mg/mmol급8．65（5．80～11．83）mg/mmol，조간비교차이무통계학의의（Z＝1．107，P＞0．05）。수궤뇨ACR여신뇨ACR상관분석현시량자정고도상관（r＝0．951，P＜0．01）；신뇨ACR、수궤뇨ACR여24 h UA균구유고도상관성，r 분별위0．886급0．859（P＜0．01）；신뇨 ACR 진단백단백뇨적민감도급특이도분별위92．6％급87．5％，수궤뇨 ACR 분별위90．1％급87．5％，량자상근。이24 h UA 작위판단표준，진행 ROC 곡선분석현시，신뇨、수궤뇨 ACR 적ROC 곡선하면적분별위（0．954±0．022）급（0．960±0．021），조간비교차이무통계학의의（Z＝1．107，P＞0．05）。결론：신뇨급수궤뇨 ACR 여24 h UA 균구유교호적상관성，균가체대24 h UA。단인수궤뇨ACR 경방편류취뇨액표본，가이교호지체대24 h UA 작위2형당뇨병조기신손상적사사급감측지표。
Objective To investigate the application of using urine ACR at different time points instead of 24-hour urinary albumin (24 h UA) for screening of early renal injury in patients with type 2 diabetes. Methods The 24-h urine samples at different time pointsfrom 89 hospitalized patients were collected. The correlations of the ACR of urine samples at different time points were compared with the 24-h UA. When the 24-h UA was taken as the standard,the receiver operating characteristic (ROC) curves of urine ACR at different time points were established and analized. Results No significant differences in urine ACR between the morning urine group [ACR 9.02 (5.69~ 11.64)mg/mmol] and the random urine group [ACR 8.65 (5.80 ~ 11.83) mg/mmol] (P > 0.05). A positive correlation was observed between the morning urine ACR and the random urine ACR (r = 0.951,P < 0.01), however, the ACR of the morning and the random urine group were all positively correlated with the 24-h UA (r=0.886, 0.859, P<0.01). There were no significant differences in the sensitivities and the specificities between the morning and the random urine specimens in screening for albuminuria (92.6%vs 90.1%, and 87.5%vs 87.5%, respectively). When the 24-h UA was taken as the standard,the area under the ROC curves of the ACR in the random urine specimens and the morning urine specimens were 0.954 ± 0.022 and 0.960 ± 0.021 , respectively. There were no statistical differences between these two groups. Conclusions The morning urine and the random urine ACR , instead of the 24-h UA , could be used for both the early screening and monitoring of the renal injury , and the random urine ACR detection is simple ,convenient and accurate for patients.