2型糖尿病患者微量白蛋白尿临界值的研究  

Research on the cut-off value of microalbuminuria among type 2 diabetes mellitus

作　　者：李蓉[1] 王华斌[1] 刘蕊[2] 崔小璠[2] 潘文洁[2] 

机构地区：[1]天津医科大学,天津300070 [2]天津市人民医院,天津300121

出　　处：《检验医学》2014年第4期319-323,共5页Laboratory Medicine

摘　　要：目的研究2型糖尿病(T2DM)患者晨尿、随机尿的尿白蛋白/肌酐比值(ACR)及尿白蛋白(U-Alb)浓度,判定微量白蛋白尿的临界值,以检测早期糖尿病肾脏疾病(DKD)。方法收集169例T2DM患者及40名健康体检者(正常对照组)的24 h尿、晨尿、随机尿,以24 h尿白蛋白排泄率(UAE)为早期DKD的判定标准,分析目前临床应用的晨尿、随机尿的ACR及U-Alb浓度判定微量白蛋白尿的临界值对早期DKD的筛查效能;根据受试者工作特征(ROC)曲线分析,Youden指数最大时对应的晨尿、随机尿的ACR及U-Alb浓度为检测早期DKD微量白蛋白尿的临界值。结果在微量白蛋白尿判定结果中,晨尿ACR与24 h UAE的符合率为43%,UAlb为37%;随机尿ACR为48%,U-Alb为41%,以上4个指标与24 h UAE的判定结果有明显差异(P均<0.001)。正常对照组晨尿、随机尿检测结果判定与24 h UAE一致,均为正常。ROC曲线分析显示ACR晨尿临界值为男16 mg/g、女23 mg/g(Youden指数分别为0.70、0.67,阴性预测值分别为97%、100%,阳性预测值分别为72%、65%);ACR随机尿临界值为男17 mg/g、女28 mg/g(Youden指数分别为0.68、0.67,阴性预测值分别为90%、90%,阳性预测值分别为61%、82%);U-Alb晨尿临界值为男16 mg/L、女15 mg/L(Youden指数分别为0.57、0.59,阴性预测值分别为84%、87%,阳性预测值分别为90%、73%);U-Alb随机尿临界值为男17 mg/L、女14 mg/L(Youden指数分别为0.56、0.53,阴性预测值分别为73%、81%,阳性预测值分别为85%、71%)。ACR的最大Youden指数均>0.6,且高于相应的U-Alb浓度的Youden指数。结论目前临床应用的晨尿、随机尿微量白蛋白尿的临界值判定T2DM患者早期肾病的漏诊率较高,应重新建立T2DM患者晨尿、随机尿ACR及U-Alb的临界值,以利于DKD的早期防治。Objective To research the cut-off value of microalbuminuria with urine albumin to creatinine ratio （ACR）and urinary albumin （U-Alb）concentration of first morning urine and random urine samples among type 2 diabetes mellitus （T2DM）,in order to detect early diabetic kidney disease （DKD）.Methods A total of 1 69 T2DM patients and 40 healthy subjects （healthy control group）were enrolled.Their 24 h urine,first morning urine and random urine samples were collected.The 24 h urinary albumin excretion （UAE）was referred as the gold standard of early DKD,and the detection effectiveness of early DKD was evaluated when applied ACR and U-Alb concentration from first morning urine and random urine samples.According to receiver operating characteristic （ROC）curve analysis,the value with the maximum Youden index was the appropriate microalbuminuria cut-off value of ACR and U-Alb concentration from first morning urine and random urine samples for detecting early DKD.Results The coincidence of ACR and U-Alb concentration with 24 h UAE from first morning urine samples were 43% and 37%,and those of ACR and U-Alb concentration from random urine samples were 48%and 41%,which were all significantly different with 24 h UAE （P〈0.001 ）.In healthy control group,the microalbuminuria judgment was totally normal and consistent with 24 h UAE.ROC curve analysis indicated that the cut-off values of ACR from first morning urine samples were male 1 6 mg/g and female 23 mg/g （Youden indices 0.7 and 0.67,negative predictive values 97%and 1 00%,and positive predictive values 72% and 65%,respestively）,and those of ACR from random urine samples were male 1 7 mg/g and female 28 mg/g（Youden indices 0.68 and 0.67,negative predictive values 90%and 90%and positive predictive values 61%and 82%,respectively）.Those of U-Alb concentration from first morning urine samples were male 1 6 mg/L and female 1 5 mg/L （Youden indices 0.57 and 0.59,negative predictive values 84% and 87%,and positive predictive values 90% and 73%,

关 键 词：白蛋白 肌酐比值 白蛋白 尿液 临界值 2型糖尿病 糖尿病肾脏疾病 

分 类 号：R446.1[医药卫生—诊断学]