微量白蛋白尿对心血管疾病死亡及全因死亡风险的预测价值  

Predictive value of microalbuminuria on cardiovascular and all-cause mortality

作　　者：李妍妍[1] 陆菊明[1] 王淑玉[2] 卢艳慧[1] 宋瑛[3] 刘力生[2] 田慧[1] 潘长玉[1] 

机构地区：[1]解放军总医院内分泌科,北京100853 [2]北京高血压联盟研究所 [3]西安东风仪表厂职工医院

出　　处：《中华糖尿病杂志》2011年第4期319-323,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：首都医学发展科研基金北京医学卫生科技联合攻关项目（2002-1009）

摘　　要：目的 对2181名中老年人在现况调查基础上进行为期4年的随访,以期对微量白蛋白尿预测心血管疾病死亡及全因死亡风险方面提供流行病学证据.方法 选取2004年6月北京中老年人群流行病学调查资料作为研究对象,记录该人群中截至2008年5月的4年期间因各种原因死亡的受检者资料.将基线人群按照尿白蛋白/肌酐（ACR）分为正常白蛋白尿组（NAU组）、微量白蛋白尿组（MIAU组）和大量白蛋白尿组（MAAU组）,比较死亡组与生存组基线时临床特征及代谢指标,在随访研究中引入Cox回归模型,调整年龄、糖尿病史、高血压史及血脂紊乱等潜在危险因素,研究不同ACR水平与心血管疾病死亡及全因死亡的关系,计算归因危险度百分比.计量资料用均数±标准差或中位数（四分位数间距）表示,组间比较用独立样本的t检验或方差分析,组间率的比较用X2检验.结果 4年期间共有77例死亡,全因死亡率为8.7/1000人年,其中心血管疾病死亡和恶性肿瘤死亡占总死亡人数的74%.与生存组相比,死亡组合并MIAU、MAAU及糖尿病的比例显著高于生存组（分别为18.2%vs 8.7%,9.1%vs 1.6%,50.6%vs 25.8%,P＜0.01）.NAU、MIAU和MAAU人群全因死亡率分别为6.8‰、20.6‰和58.8‰.在NAU人群中,恶性肿瘤是该人群的首要死亡原因,其次是心血管疾病.而在MIAU人群和MAAU人群中,心血管疾病为该人群的首要死亡原因.校正年龄、血糖、高血压、血脂异常等因素后,与NAU组相比,MIAU组的心血管疾病死亡风险增加了1.72倍,全因死亡风险增加1.01倍,MAAU组心血管疾病死亡风险增加了3.87倍,全因死亡风险增加2.76倍.以NAU组为对照,经Cox回归调整年龄、血糖、血压、血脂紊乱后,分析不同尿白蛋白排泄率（UAER）组心血管疾病死亡及全因死亡人群归因危险度百分比,18.32%的心血管疾病死亡及11.96%的全因死亡见于ACR≥30 mg/g.结论恶性肿瘤是NAU人群的�Objective To analyze the effect of microalbuminuria on predicting cardiovascular disease mortality and total mortality risk in 2181 subjects.Methods These subjects came from Beijing epidemiological data in the moderate-elderly population in June 2004.After 4 years follow up, the death of various reasons were observed of death of four-year period for various reasons in May 2008.In according to the albumin creatinine ratio （ACR） value, all subjects were divided into normal albuminuria group （NAU group）, microalbuminuria group （MIAU group） and macroalbuminuria group （MAAU in according to the ACR）.The various causes of death were analyzed, and the baseline clinical characteristics and metabolic markers were compared between the death group and survival group.In the follow-up, Cox regression model was used.After adjusted for age, DM history, history of hypertension, dyslipidemia and other potential risk factors, the relationship between ACR levels and cardiovascular- or all-cause mortality was analyzed.Results Totally 77 subjects died during the 4 years follow up.The all-cause mortality was 8.7/1000 person-year in total population.The CVD and malignant tumor were the main causes of death.Compared with the survival population,the proportion of MIAU, MAAU, and DM were significantly higher in the death population （ 18.2% vs 8.7% ,9.1% vs 1.6%, 50.6% vs 25.8%, P 〈 0.01 ）.The all-cause mortality was 6.8‰,20.6‰ and 58.8 ‰ in NAU, MIAU, MAAU population respectively.In the NAU population, malignant tumor was the leading cause of death, followed by cardiovascular disease.While in MIAU and MAAU population, cardiovascular disease was the primary cause of death.After age, blood glucose, hypertension,dyslipidemia and other factors were adjusted, compared with the NAU, the risk of death of cardiovascular disease was increased by 1.72 times and the all-cause death increased by 1.01 times in MIAU group, risk of death of cardiovascular disease increased by 3.87 times and of all-cause death increased by 2.76

关 键 词：白蛋白尿 心血管疾病 死亡率 

分 类 号：R54[医药卫生—心血管疾病]