与尿蛋白肌酐比值(uPCR)相比,试纸蛋白尿在非糖尿病生活方式相关疾病中预测微量白蛋白尿的实用性以及试纸蛋白尿对uPCR的临界值(CO)和准确性的影响尚不清楚。
受试者包括年龄≥18岁的日本患者,患有与生活方式相关的疾病,其肾小球滤过率估计≥15ml/min/1.73m2,uPCR在开始时<0.5g/gCr。尿液试纸,uPCR和尿白蛋白-肌酐比值(uACR)每例测定3次。对于3次测量中的至少2次,微量白蛋白尿被定义为30-299mg/gCr的uACR。尤登指数被用作最优CO。使用逻辑回归模型分析与微量白蛋白尿相关的因素。
在313例非糖尿病病例(中位年龄70.8岁)中,3试纸蛋白尿测量独立用于检测微量白蛋白尿,并且当至少3次获得痕量发现时设定CO(敏感性0.56,特异性0.80,阳性预测值[PPV]0.73,阴性预测值[NPV]0.65)。单个uPCR测量比3个试纸测量更有用,即使在三个连续蛋白尿阴性的病例中,也可用于检测微量白蛋白尿,表明用G1-3a(n=136)进行第二次uPCR的CO为0.06g/gCr(敏感性0.76,特异性0.84。PPV0.68,净现值0.89),而G3-b4(n=59)为0.10g/gCr(敏感性0.56,特异性0.91。PPV0.83,净现值0.71)。在G1-3a(灵敏度0.67,特异性0.94,NPV0.86)和G3b-4(灵敏度0.78,特异性0.94,PPV0.91NPV0.83)的病例中,3个uPCR的总和可用于检测微量白蛋白尿。两种CO均为0.23g/gCr。当包括微量或更多的蛋白尿时,微量白蛋白尿的这些COs没有变化,虽然灵敏度增加。在蛋白尿阴性的情况下,高uPCR和低尿比重或肌酐水平是uACR≥30mg/gCr的独立因素。尽管uPCR是uACR≥30mg/gCr的主要预测因素。
uPCR(最好使用清晨尿液确定),包括非糖尿病生活方式相关疾病的试纸阴性蛋白尿病例,可以帮助早期发现微量白蛋白尿。
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The utility of dipstick proteinuria for predicting microalbuminuria in non-diabetic lifestyle-related diseases compared with the urine protein-to-creatinine ratio (uPCR) and the effect of dipstick proteinuria on the cut-off value (CO) and accuracy of uPCR are unclear.
The subjects included Japanese patients ≥ 18 years old with lifestyle-related diseases who had an estimated glomerular filtration rate of ≥ 15 ml/min/1.73 m2 and uPCR of < 0.5 g/gCr at initiation. Urine dipstick, uPCR and urine albumin-to-creatinine ratio (uACR) were measured three times per case. Microalbuminuria was defined as uACR of 30-299 mg/gCr for at least 2 of 3 measurements. Youden\'s Index was used as the optimal CO. Factors associated with microalbuminuria were analyzed using a logistic regression model.
In 313 non-diabetic cases (median 70.8 years old), 3 dipstick proteinuria measurements were independently useful for detecting microalbuminuria, and the CO was set when a trace finding was obtained at least 1 of 3 times (sensitivity 0.56, specificity 0.80, positive predictive value [PPV] 0.73, negative predictive value [NPV] 0.65). A single uPCR measurement was more useful than 3 dipstick measurements, and was useful for detecting microalbuminuria even in cases with three consecutive negative proteinuria findings, indicating that the CO of the second uPCR with G1-3a (n = 136) was 0.06 g/gCr (sensitivity 0.76, specificity 0.84. PPV 0.68, NPV 0.89), while that with G3-b4 (n = 59) was 0.10 g/gCr (sensitivity 0.56, specificity 0.91. PPV 0.83, NPV 0.71). The sum of 3 uPCRs was useful for detecting microalbuminuria in cases with G1-3a (sensitivity 0.67, specificity 0.94, PPV 0.82, NPV 0.86) and G3b-4 (sensitivity 0.78, specificity 0.94, PPV 0.91 NPV 0.83), with both COs being 0.23 g/gCr. These COs of microalbuminuria did not change when trace or more proteinuria was included, although the sensitivity increased. A high uPCR and low urine specific gravity or creatinine level were independent factors for uACR ≥ 30 mg/gCr in cases with negative proteinuria, although the uPCR was a major predictive factor of a uACR ≥ 30 mg/gCr.
The uPCR (preferably determined using early-morning urine), including in dipstick-negative proteinuria cases with non-diabetic lifestyle-related diseases, can aid in the early detection of microalbuminuria.
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