天津地区成人晨尿ACR及白蛋白浓度生物参考区间的调查研究

doi:10.3969/j.issn.1673-8640.2015.12.007

摘要/Abstract

摘要：

目的调查天津地区20~60岁健康人群晨尿白蛋白/肌酐比值(ACR)及尿白蛋白浓度的参考区间。方法根据纳入标准,从体检人群中选取500名健康人群(20~60岁)入组,收集入组人群的晨尿,检测其尿白蛋白(散射免疫比浊法)及尿肌酐浓度,计算ACR。根据美国临床实验室标准化协会(CLSI)EP15-A及C28-A2文件,采用Z检验分析数据并建立相应的ACR及尿白蛋白浓度的参考区间。结果 Z检验结果显示同一性别不同年龄段人群的ACR及尿白蛋白浓度差异无统计学意义(P>0.05),无需按年龄进行分组建立参考区间;男性尿白蛋白浓度高于女性(P<0.05),需建立性别特异的尿白蛋白浓度参考区间;男、女性ACR差异无统计学意义(P>0.05),可建立统一的ACR生物参考区间。尿ACR及白蛋白浓度均呈非正态分布(P<0.05),因此采用第95百分位数(P₉₅)确定尿ACR及尿白蛋白的参考区间。尿ACR的参考区间为0~12.40 mg/g;尿白蛋白男性为0~18.72 mg/L,女性为0~14.27 mg/L。结论天津地区健康人群晨尿ACR和白蛋白的参考区间明显低于目前临床推荐使用的参考区间;ACR可建立统一的参考区间,但尿白蛋白需考虑性别间的差异并建立不同的参考区间。

关键词: 白蛋白/肌酐比值, 白蛋白, 尿液, 生物参考区间, 健康成人

Abstract:

Objective To survey the reference intervals of urine albumin-creatinine ratio(ACR) and urinary albumin concentration in first morning urine samples from 20-60-year-old healthy subjects in Tianjin.Methods According to the inclusion criteria, 500 healthy subjects(20-60-year-old) were enrolled in this study. Their first morning urine samples were collected, and the concentration of urinary albumin (nephelometry immunoassay)and creatinine were determined, and urine ACR was calculated. According to the Clinical and Laboratory Standards Institute (CLSI) EP15-A and C28-A2, Z test was performed to analyze the data and was used to establish the reference intervals of urine ACR and urinary albumin concentration. Results There was no statistical significance among different ages in both male and female groups (P>0.05), and it was not necessary to establish the age-specific reference intervals for urine ACR and urinary albumin concentration. Males, on average, had higher urinary albumin concentration than females(P<0.05), and the sex-specific reference interval was needed. For urine ACR, there was no statistical significance with sex (P>0.05), and the uniform reference interval could be used in males and females. The distributions of urine ACR and urinary albumin concentration were skewed (P<0.05), so we used the 95th percentile(P₉₅) as the reference interval. The urine ACR reference interval was 0-12.40 mg/g, and the urinary albumin reference intervals were 0-18.72 mg/L for male and 0-14.27 mg/L for females. Conclusions The urine ACR and urinary albumin concentration reference intervals among healthy subjects in Tianjin are lower than those recommended by clinical guidelines. There is no sex difference for ACR. However, it exists sex difference for urinary albumin concentration, and it needs different reference intervals for males and females.

Key words: Albumin-creatinine ratio, Albumin, Urine, Biological reference interval, Healthy adult

中图分类号:

R446.1

崔小璠, 李蓉, 王华斌, 刘蕊, 潘文洁. 天津地区成人晨尿ACR及白蛋白浓度生物参考区间的调查研究[J]. 检验医学, 2015, 30(12): 1193-1197.

CUI Xiaofan, LI Rong, WANG Huabin, LIU Rui, PAN Wenjie. Investigation on the reference intervals of first morning urine ACR and urinary albumin concentration among adults in Tianjin[J]. Laboratory Medicine, 2015, 30(12): 1193-1197.

图/表 4

表1 500名研究对象的基本信息

性别	例数	年龄(岁)	体重指数(kg/m²)	收缩压(kPa)	舒张压(kPa)	空腹血糖(mmol/L)	TG(mmol/L)
男性	250	40.98±11.32	23.13±1.97	14.97±1.61	9.80±1.13	5.34±0.40	1.10±0.57
女性	250	40.14±11.22	21.90±2.15	13.91±1.79	9.52±1.12	5.11±0.42	0.93±0.40
〗性别	例数	TC (mmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	尿白蛋白 (mg/L)	尿肌酐 (mmol/L)	ACR (mg/g)
男性	250	4.64±0.82	2.92±0.56	1.42±0.29	7.11(2.12~28.70)	13.25(1.88~29.11)	4.83(1.20~19.94)
女性	250	4.59±0.79	2.89±0.19	1.56±0.28	4.37(2.12~21.80)	7.39(1.43~25.40)	5.19(1.14~30.85)

表2 同性别不同年龄组ACR、尿白蛋白浓度的Z检验分析

组别	例数	尿白蛋白(mg/L)				ACR(mg/g)
组别	例数	$x ?$	s	范围	结论	$x ?$	s	范围	结论
男性
20~40岁组	125	8.15	5.23	2.12~28.70	Z<Z^*, s₂<1.5s₁,	5.28	2.97	1.20~19.94	Z<Z^*, s₂<1.5s₁,
41~60岁组	125	7.9	5.24	2.12~27.60	P>0.05	6.07	3.57	1.45~19.83	P>0.05
女性
20~40岁组	125	5.69	3.85	2.12~20.80	Z<Z^*, s₁<1.5s₂,	6.04	3.93	1.14~30.85	Z<Z^*, s₁<1.5s₂,
41~60岁组	125	4.47	3.69	2.12~21.80	P>0.05	6.19	3.14	1.53~20.48	P>0.05

表2 同性别不同年龄组ACR、尿白蛋白浓度的Z检验分析

组别	例数	尿白蛋白(mg/L)				ACR(mg/g)
组别	例数	$x ?$	s	范围	结论	$x ?$	s	范围	结论
男性
20~40岁组	125	8.15	5.23	2.12~28.70	Z<Z^*, s₂<1.5s₁,	5.28	2.97	1.20~19.94	Z<Z^*, s₂<1.5s₁,
41~60岁组	125	7.9	5.24	2.12~27.60	P>0.05	6.07	3.57	1.45~19.83	P>0.05
女性
20~40岁组	125	5.69	3.85	2.12~20.80	Z<Z^*, s₁<1.5s₂,	6.04	3.93	1.14~30.85	Z<Z^*, s₁<1.5s₂,
41~60岁组	125	4.47	3.69	2.12~21.80	P>0.05	6.19	3.14	1.53~20.48	P>0.05

表3 不同性别间尿白蛋白、ACR检测的Z检验分析结果

性别	例数	尿白蛋白(mg/L)					ACR(mg/g)
性别	例数	$x ?$	s	范围	结论		$x ?$	s	范围	结论
男性	250	8.02	5.24	2.12~28.70	Z﹥Z^*, s₁>1.5s₂,	5.69	3.31	1.20~19.94	Z<Z^*, s₂<1.5s₁,
女性	250	5.09	3.81	2.12~21.80	P<0.05	6.11	3.56	1.14~30.85	P>0.05

表3 不同性别间尿白蛋白、ACR检测的Z检验分析结果

性别	例数	尿白蛋白(mg/L)					ACR(mg/g)
性别	例数	$x ?$	s	范围	结论		$x ?$	s	范围	结论
男性	250	8.02	5.24	2.12~28.70	Z﹥Z^*, s₁>1.5s₂,	5.69	3.31	1.20~19.94	Z<Z^*, s₂<1.5s₁,
女性	250	5.09	3.81	2.12~21.80	P<0.05	6.11	3.56	1.14~30.85	P>0.05

表4 不同性别人群尿白蛋白、ACR检测结果分布

性别	尿白蛋白(mg/L)				尿肌酐(mmol/L)				ACR(mg/g)
性别	P₂₅	P₅₀	P₇₅	P₉₅	P₂₅	P₅₀	P₇₅	P₉₅	P₂₅	P₅₀	P₇₅	P₉₅
男性	4.80	7.11	10.70	18.72	9.50	13.25	17.03	22.83	3.79	4.83	6.76	12.89
女性	2.77^*	4.37^*	6.84^*	14.27^*	4.78^*	7.39^*	11.43^*	16.20^*	4.29	5.19	6.99	13.34

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