随机尿微量白蛋白肌酐比值在糖尿病及高血压肾损伤诊疗中的价值

摘要

目的 探讨随机尿微量白蛋白肌酐比值(ACR)在糖尿病及高血压肾损伤患者诊断及治疗中的价值.方法 糖尿病或高血压患者共62例(糖尿病30例,高血压32例),并按1989年Mogensen标准,根据尿白蛋白排泄率(UAER)分为三组:正常白蛋白尿组(UAER＜30mg/24h)20例,微量白蛋白尿组(UAER30～300mg/24h)20例,大量白蛋白尿组 (UAER＞300mg/24h)22例,均经内科正规治疗;留取24小时尿液计算UAER,治疗前后均留取随机尿测定尿微量白蛋白 (UmAlb)及尿肌酐进行比较.结果 随机尿ACR与UAER呈现明显的正相关(r=0.78,P＜0.01),与UmAlb也呈明显正相关(r=0.77,P＜0.01);肾损伤各组ACR及UmAlb检测结果比较中,UmAlb在对照组和正常白蛋白尿组比较无意义(P＞ 0.05),ACR则有显著差异(P＜0.01);在评价肾损伤的敏感性比较中,ACR在正常白蛋白尿组阳性率达35.0%,UmAlb阳性率仅5.0%,两者阳性率比较有显著差异(χ2=3.91,P＜0.05);治疗前后各组ACR及UmAlb检测结果比较中,正常白蛋白尿组的UmAlb治疗前后检测结果比较P＜0.05,ACR治疗前后检测结果比较P＜0.01.结论 随机尿ACR与UAER及UmAlb有着极好的相关性,在肾功能早期损伤的诊断及治疗后的疗效观察中均优于UmAlb,可以作为替代UAER及UmAlb作为肾病早期诊断及疗效观察的有效指标.%Objective To study the diagnostic and treatment value of random urinary microalbuminuria/ creatinine ratio in diabetes mellitus and hypertension renal injury.Methods 62 patients with diabetes mellitus or hypertension(30 diabetes mellitus patients and 32 hypertension patients) were divided into three groups according to the method of Mogensen's,lodged in 1989:normal urinary albumin group,urinary albumin excretions(UAER) <30mg/24hours(n=20),minimal urinary albumin group,UAER30~300mg/24hours(n=20),and mass urinary albumin group,UAER>300mg/24hours(n=22).All groups had regular medical treatment.24 hours urine were left to calculate the UAER,random urine to determine urinary microalbuminuria (UmAlb),and creatinine making a comparison before and after treatment. Results There were obviously positive correlation between random urinary ACR and UAER(r=0.78,P<0.01),and positive correlation with UmAlb too(r=0.77,P<0.01).There was insignificant difference of UmAlb in comparison between the control group and the normal urinary albumin group(P>0.05),but ACR had significant difference between the two groups(P<0.01).The positive rate of ACR in the normal urinary albumin group was 35.0%,UmAlb was only 5.0% in the comparison of evaluation of the sensitivity of the renal injury.Both positive rate had significant difference of ;x2(x2=3.91,P<0.05);The comparison of UmAlb test results before and after treatment was P<0.05,ACR was P<0.01 in the normal urinary albumin group.Conclusion There has a good correlation between random urinary ACR with UAER and UmAlb,and they were better than UmAlb in early diagnose renal injury and the curative effects after treatment.It can be used to substitute UAER and UmAlb as an effective mark in early diagnosis of renal disease and efficacy watch.