晨尿与随机尿微量白蛋白作为糖尿病肾病诊断试验有效性评价  

The Validity Evaluation of Morning and Random Urinary Microalbumin as A Diagnosis Test for Diabetic Nephropathy

作　　者：马清光 张昕明 高梅[2] 

机构地区：[1]上海市大场医院检验科,上海200436 [2]哈尔滨242医院检验科,哈尔滨150000

出　　处：《循证医学》2009年第1期36-40,共5页The Journal of Evidence-Based Medicine

摘　　要：目的了解和评价晨尿、随机尿微量白蛋白作为糖尿病肾病诊断试验评价指标的有效性。方法计算机检索MEDLINE和EMBASE(1980-2007年),检索词"microalbuminuria,diabetic nephropathy",中文检索中国生物医学文献数据库CBMdisc(1990-2007年),检索词"尿微量白蛋白,糖尿病肾病"。选择糖尿病肾病与晨尿微量白蛋白和随机尿微量白蛋白的相关研究,查找全文,并按纳入标准逐项分析,通过Meta分析评价四种检测方法作为糖尿病肾病诊断试验的有效性。结果检索出3456篇文献,中文504篇、英文2952篇。符合纳入标准的文献11篇,中文2篇、英文9篇。按留尿方法分:随机尿6篇、晨尿5篇。Meta分析得到受试者工作特征曲线下面积:随机尿直接法曲线下面积为0.943,95%可信区间为(0.918,0.968);随机尿校正法曲线下面积为0.952,95%可信区间为(0.950,0.954);晨尿直接法曲线下面积为0.915,95%可信区间为(0.884,0.946);晨尿矫正法曲线下面积为0.979,95%可信区间为(0.969,0.989),P>0.05。结论晨尿与随机尿微量白蛋白诊断糖尿病肾病的有效性均较高,两者间差异无统计学意义,对微量蛋白尿阶段尚不能肯定四种方法何者为优,应开展大样本量、高质量的临床研究进一步分析。Objective To analyze the status of applying morning and random urinary microalbumin as a diagnosis test for diabetic nephropathy and to evaluate the validity of diagnosis value. Methods This was systematic review of diagnosis test. We searched the original articles of morning and random urinary mieroalbumin and 24h urine albumin excretion rate （UAER） obtained from diabetic nephropathy patients was studied. All articles were identified from MEDLINE and EMBASE （1980-2007） and Chinese Bio-medicine Database （1990-2007）. We also consulted the articles and analyses on diagnosis test parameters, and meta-analyzed the validity of four methods as a diagnosis test for diabetic nephropathy. Results We searched 504 original articles in “Chinese Journal” and 2 952 English original articles with the 3 456 studies. 11 studies met the inclusion criteria in these articles, with 6 studies in random and 5 studies in morning urinary. The calculated area was under the ROC curves for random urinary specimen [AUC=0.943, 95%CI （0.918,0.968）] and random urinary albumin/ereatinine ratio [AUC=0.952, 95%CI （0.950,0.954）] and morning urinary speatiniue [AUC=0.915, 95%CI（0.884,0.946）] and roofing urinary albumin/ creatinine ratio [AUC=0.979, 95%CI （0.969,0.989） ] （P〉0.05）. Conclusions Morning and random uriary mioroalbumin were considered as valid test for use in screening for diabetic nephropachy, but no definite conclusion can be drawn as to which method is superior in mieroalbuminuria. To make further analysis, more studies with high quality are needed.

关 键 词：糖尿病.肾病 尿微量白蛋白 晨尿 随机尿 系统综述 

分 类 号：R587.205[医药卫生—内分泌] R692.05[医药卫生—内科学]