上海一社区人群尿白蛋白/肌酐比值及估算肾小球滤过率异常率流行病学调查

doi:10.3969/j.issn.1673-8640.2015.04.009

摘要/Abstract

摘要：

目的分析尿白蛋白(Alb)及估算肾小球滤过率(eGFR)在上海一社区老年人群中的分布情况,分析其相关危险因子,为肾脏疾病的诊疗提供流行病学数据。方法随机选取上海市宝山区友谊社区60岁以上居民1 154名,收集受访者空腹静脉血和晨尿,计算尿Alb/肌酐(Cr)比值(ACR),并用慢性肾病流行病学协作组(CKD-EPI)方程计算eGFR。以ACR≥30 mg/mgCr、eGFR≤60 mL/(min·1.73 m²)为切点判断Alb尿及肾小球滤过率(GFR)受损,计算人群患病率并分析不同危险因素与疾病的关系。使用肾脏疾病膳食改良(MDRD)方程计算eGFR,比较其与CKD-EPI方程计算结果间的差异。结果1 154名60岁以上人群中有13.43%的个体出现Alb尿,29.98%存在GFR受损。随着年龄的上升,ACR和eGFR_CKD-EPI的异常率明显上升。Alb尿组性别构成、年龄、糖尿病患病率和高血压患病率与正常组比较,差异均有统计学意义(其中性别构成P<0.05,其余项目P均<0.001); GFR受损组除年龄和高血压患病率与GFR正常组比较差异有统计学意义(P<0.001、P=0.006)外,其他因素差异均无统计学意义(P>0.05)。使用MDRD公式计算eGFR会较使用CKD-EPI公式得到更高的eGFR异常率,在高年龄组和ACR正常组内尤为明显。MDRD方程可能高估了eGFR的异常率,低估了健康人群的eGFR水平,CKD-EPI公式相对更为准确。结论ACR升高及eGFR异常在老年群体中有着较高的发生率,这一群体需要增加对肾脏疾病及糖尿病和高血压等危险因素的关注。使用公式估算eGFR时需要注意不同公式在不同群体间的差异。

关键词: 尿白蛋白/肌酐比值, 估算肾小球滤过率, 流行病学

Abstract:

Objective In order to provide the epidemiological data for clinical diagnosis, to analyze the distribution of urinary albumin (Alb) and estimated glomerular filtration rate (eGFR) in one-community elderly residents of Shanghai and the related risk factors. MethodsA total of 1 154 residents were randomly enrolled from Youyi Community, Baoshan District. All of them were ≥60 years old. Fasting blood and first morning urine samples were collected to measure and calculate urinary Alb/creatinine (Cr) ratio(ACR) and eGFR by the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI) equation. ACR≥30 mg/mgCr and eGFR≤60 mL/(min·1.73 m²) were used as the cut-off points to define albuminuria and impaired glomerular filtration rate (GFR). The prevalence and relationships between risk factors and disease were analyzed. The eGFR was calculated according to modification of diet in renal disease (MDRD) equation. Difference between the results of CKD-EPI equation and MDRD equation were also compared. ResultsOverall, 13.43% of the residents had albuminuria, and 29.98% of the residents existed impaired GFR. The abnormal rates of ACR and eGFR_CKD-EPI increased with sex, age, prevalence rate of diabetes mellitus, prevalence rate of hypertension showed statistical significance between normal group and albuminuria group (for sex: P<0.05; for the others: P<0.001). In impaired GFR group, all factors showed no statistical significances except age (P<0.001) and hypertension (P=0.006) compared with normal group (P>0.05). Compared with CKD-EPI equation, MDRD equation may get a higher abnormal rate of eGFR. MDRD equation may overestimate the abnormal rate and underestimate the eGFR levels of healthy subjects, especially in the elderly group and ACR normal group. CKD-EPI equation was relatively more accurate. ConclusionsThe prevalence of increasing ACR and abnormal eGFR is high among the elderly residents. Therefore, these individuals need to pay more attention to kidney disease, diabetes mellitus, hypertension and other risk factors. Clinicians should be aware of the differences of eGFR on the basis of different equations among different populations.

Key words: Urinary albumin/creatinine ratio, Estimated glomerular filtration rate, Epidemiology

中图分类号:

R446.1

施美芳, 吴炯, 唐文佳, 戴谦, 张春燕, 宋斌斌, 王蓓丽, 郭玮, 潘柏申. 上海一社区人群尿白蛋白/肌酐比值及估算肾小球滤过率异常率流行病学调查[J]. 检验医学, 2015, 30(4): 331-336.

SHI Meifang, WU Jiong, TANG Wenjia, DAI Qian, ZHANG Chunyan, SONG Binbin, WANG Beili, GUO Wei, PAN Baishen. An epidemiological study on the abnormal rates of urinary albumin/creatinine ratio and estimated glomerular filtration rate in one-community residents of Shanghai[J]. Laboratory Medicine, 2015, 30(4): 331-336.

图/表 7

参考文献 15

[1]	ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China: a cross-sectional survey[J]. Lancet,2012,379(9818):815-822.
[2]	SAYDAH SH,PAVKOV ME,ZHANG C,et al.Albuminuria prevalence in first morning void compared with previous random urine from adults in the National Health and Nutrition Examination Survey,2009-2010[J]. Clin Chem,2013,59(4): 675-683.
[3]	MCLLROY DR,WAGENER G,LEE HT.Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance[J]. Clin J Am Soc Nephrol,5(2): 211-219.
[4]	GU DF,SHI YL,CHEN YM,et al.Prevalence of chronic kidney disease and prediabetes and associated risk factors: a community-based screening in Zhuhai,Southern China[J]. Chin Med J (Engl),2013,126(7): 1213-1219.
[5]	李蓉,王华斌,刘蕊,等. 2型糖尿病患者微量白蛋白尿临界值的研究[J]. 检验医学,2014,29(4):319-323.
[6]	LI ZY,XU GB,XIA TA,et al.Prevalence of chronic kidney disease in a middle and old-aged population of Beijing[J]. Clin Chim Acta,2006,366(1-2): 209-215.
[7]	ROBLES NR,FELIX FJ,FERNANDEZ-BERGES D,et al.Prevalence of abnormal urinary albumin excretion in elderly people: a Spanish survey[J]. Int Urol Nephrol,2013,45(2): 553-560.
[8]	ROBERTS J,MAURER K. Blood pressure levels of persons 6-74 years. United States,1971-1974[J].Vital Health Stat 11, 1977, 203: i-v.
[9]	陈汉红,云大壮,吴璐思,等. 血清半胱氨酸蛋白酶抑制剂C对高血压患者早期肾损伤的诊断性能评价[J]. 检验医学,2011,26(5):317-320.
[10]	赵龙, 关广聚. 糖尿病肾病发病机制研究进展[J]. 中华肾脏病杂志,2013,29(7):554-558.
[11]	刘俊峰,鞠萍,黄娟. 血清及尿中微量元素铬的水平与2型糖尿病肾病的相关性分析[J]. 检验医学,2014,29(10):1023-1027.
[12]	CIRILLO M,LOMBARDI C,LUCIANO MG,et al.Estimation of GFR: a comparison of new and established equations[J]. Am J Kidney Dis,2010,56(4): 802-804.
[13]	MATSUSHITA K,MAHMOODI BK,WOODWARD M,et al.Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate[J]. JAMA,2012,307(18): 1941-1951.
[14]	LEVEY AS,STEVENS LA,SCHMID CH,et al.A new equation to estimate glomerular filtration rate[J]. Ann Intern Med,2009,150(9): 604-612.
[15]	ARORA P, VASA P, BRENNER D,et al.Prevalence estimates of chronic kidney disease in Canada: results of a nationally representative survey[J]. CMAJ,2013,185(9): E417-E423.

年龄(岁)	例数	ACR(mg/g)	ACR异常率(%)	eGFR_CKD-EPI [mL/(min·1.73 m²)]	eGFR异常率(%)
61~	415	8.6(7.2~12.1)	8.89	70.52(63.39~76.62)	14.66
71~	566	8.8(7.3~15.5)	15.19	65.37(58.02~72.56)	30.04
81~	170	9.2(7.3~21.2)	17.65	55.89(46.78~63.75)	66.47
>90	3	33.6(8.5~218.0)	66.67	44.84(32.74~58.63)	100.00

年龄(岁)	例数	ACR(mg/g)	ACR异常率(%)	eGFR_CKD-EPI [mL/(min·1.73 m²)]	eGFR异常率(%)
61~	415	8.6(7.2~12.1)	8.89	70.52(63.39~76.62)	14.66
71~	566	8.8(7.3~15.5)	15.19	65.37(58.02~72.56)	30.04
81~	170	9.2(7.3~21.2)	17.65	55.89(46.78~63.75)	66.47
>90	3	33.6(8.5~218.0)	66.67	44.84(32.74~58.63)	100.00

项目	ACR(mg/g)			eGFR[mL/(min·1.73 m²)]
项目	<30	≥30	P值	≤60	>60	P值
例数	999	155		347	807
性别
男	391	82	0.002	146	326	0.595
女	608	73		201	481
年龄(岁)	73.10±5.87	75.17±6.15	<0.001	76.88±6.08	71.87±5.21	<0.001
BMI(kg/m²)	24.64±3.55	24.68±3.46	0.904	24.83±3.64	24.56±3.49	0.239
糖尿病(例)	148	47	<0.001	64	131	0.359
高血压(例)	493	108	<0.001	202	399	0.006
饮食习惯
素食为主	191	17	0.292	64	144	0.955
荤素均衡	782	131		272	641
荤食为主	26	7		11	22
血糖(mmol/L)	5.5±1.60	5.85±1.92	0.01	5.58±1.66	5.55±1.64	0.711

项目	ACR(mg/g)			eGFR[mL/(min·1.73 m²)]
项目	<30	≥30	P值	≤60	>60	P值
例数	999	155		347	807
性别
男	391	82	0.002	146	326	0.595
女	608	73		201	481
年龄(岁)	73.10±5.87	75.17±6.15	<0.001	76.88±6.08	71.87±5.21	<0.001
BMI(kg/m²)	24.64±3.55	24.68±3.46	0.904	24.83±3.64	24.56±3.49	0.239
糖尿病(例)	148	47	<0.001	64	131	0.359
高血压(例)	493	108	<0.001	202	399	0.006
饮食习惯
素食为主	191	17	0.292	64	144	0.955
荤素均衡	782	131		272	641
荤食为主	26	7		11	22
血糖(mmol/L)	5.5±1.60	5.85±1.92	0.01	5.58±1.66	5.55±1.64	0.711

危险因素	OR值	P值
性别(男)	1.754(1.248~2.464)	0.001
年龄	1.058(1.020~1.088)	<0.01
糖尿病史	2.502(1.704~3.675)	<0.01
高血压史	2.358(1.638~3.395)	<0.01
血糖	1.887(1.330~2.677)	<0.01