三种单次时点尿公式估算儿童24小时尿钠排出量的准确性研究  

Evaluation on the Accuracy of 3 Formulas for Estimation of 24-hour Urinary Sodium Excretion Using Single Spot Urine Sample in Children

作　　者：彭亚光[1] 刘丽丽[1] 张莹[1] 马殿群[1] 解鲜冬[1] 翟士芬 张连新[1] 李昆 彭晓霞[1] 张淑华[1] PENG Yaguang;LIU Lili;ZHANG Ying;MA Dianqun;XIE Xiandong;ZHAI Shifen;ZHANG Lianxin;LI Kun;PENG Xiaoxia;ZHANG Shuhua(National Center for Children's Health, China, Key Laboratory of Pediatric Major Diseases Research, Ministry of Education, Beijing Children's Hospital, Capital Medical University, Beijing (100045), China)

机构地区：[1]首都医科大学附属北京儿童医院国家儿童医学中心儿科重大疾病研究教育部重点实验室

出　　处：《中国循环杂志》2019年第8期803-809,共7页Chinese Circulation Journal

基　　金：市委组织部优秀人才项目（2017000021469G245）;北京市医管局“青苗”人才项目（QWL20171203）;首都医科大学基础临床科研基金（17JL85)

摘　　要：目的:比较单次时点尿估算24小时尿钠排出量的三种常用公式在儿童中应用的准确性。方法:采用横断面研究设计,基于医院人群,收集5~18周岁儿童完整24小时内各次尿样及24小时尿样,并检测尿钠、钾、肌酐浓度,利用Kawasaki(K法)、INTERSALT(I法)和Tanaka(T法)公式,比较24小时尿钠排出量估计值与实测值绝对偏差、相对偏差分布,分析错分情况,评估准确性。结果:最终纳入分析129例儿童,年龄范围设定5~18周岁。24小时尿钠排出量均值为2694.9mg/d,K法、I法、T法公式估计值分别为5087.5mg/d、2721.3mg/d和3000.6mg/d;人群水平绝对偏差均值:K法最高(2367.6mg/d),I法、T法分别为26.4mg/d和258.8mg/d;个体估计值与实测值相对偏差超过40%的比例,K法、I法和T法分别为79.8%、34.9%和38.5%,相对偏差低于20%比例均不超过35%;折算成盐摄入量后,K法、I法和T法估计值总体错分率分别为73.1%、69.0%和62.4%。现有公式在儿童中存在低值高估与高值低估的情况。结论:单次时点尿估算24小时尿钠排出量,I法、T法在估算儿童人群水平准确性尚可,但估计个体水平时三个公式准确性均较差,应进一步研究提高评估准确性的方法。Objectives:To compare the accuracy of three 24-hour urinary sodium excretion estimation formulas using single spot urine in children.Methods:A hospital-based cross-sectional study was designed.24 hours urine samples were collected,urine sample at each urination was also collected from 129 children aged 5-18 years.Urine concentration of sodium,potassium and creatinine in spot samples and 24-hour samples were measured and the deviation between the estimated values and measured values of 24-hour urinary sodium excretion(24-h USE) was evaluated using three common used formulas,Kawasaki,INTERSALT,and Tanaka formulas.Based on the salt intakes estimated by converting the 24-h USE,the misclassification analysis was conducted to evaluate the accuracy of the three formulas.Results:The 24-h USE derived from the whole 24 hours urine sample was 2 694.9 mg for children,while the estimated values by using three formulas were 5 087.5 mg/d,2 721.3 mg/d,3 000.6 mg/d respectively.The mean of the difference between estimated value and measured value of three formulas were 2 367.6 mg/d,26.4 mg/d and 258.8 mg/d respectively.The distribution percentage of relative deviation ≥ 40% in Kawasaki,INTERSALT and Tanaka were 79.8%,34.9%,and 38.5% respectively.Prevalence of the distribution of relative deviation ≤ 20% was less than 35% among the 3 formulas.The misclassification rate of Kawasaki,INTERSALT and Tanaka formulas were 73.1%,69.0%,62.4% respectively.Conclusions:Kawasaki,INTERSALT and Tanaka formulas using single spot urine sample are not suitable for children to evaluate the 24-hour urinary sodium excretion,is associated with low accuracy,especially at individual level.It is necessary to improve the accuracy of urinary sodium excretion evaluation model for children in further studies.

关 键 词：24小时尿钠 时点尿 儿童 高血压 

分 类 号：R541.4[医药卫生—心血管疾病]