摘要目的 分析尿白蛋白/肌酐比值(ACR)与24h尿微量白蛋白(UMA)的相关性和ACR对早期糖尿病肾病的预测能力,并研究控制各代谢指标的影响下,ACR对早期糖尿病肾病的预测能力变化.方法 回顾性收集368例符合入排标准的2型糖尿病患者资料,计算ACR与24 h UMA的相关性及ACR诊断早期糖尿病肾病的接受者操作特征(ROC)曲线下面积;将性别、年龄、病程、空腹静脉血糖、糖化血红蛋白、血压、甘油三酯、总胆固醇作为调整变量,分别建立ACR与24 h UMA的单因素和多因素logistic回归模型,评价预测模型对早期糖尿病肾病的诊断能力.结果 ACR与24 h UMA相关性为0.658,ACR诊断早期糖尿病肾病的ROC曲线下面积为0.907;调整变量调整前回归模型ACR的OR值为2.016,调整后ACR的OR值为2.762;Hosmer-Lemeshow卡方检验评价模型校准度,调整前模型卡方值为19.362,调整后卡方值为14.928;调整后回归模型拟合ROC曲线下面积为0.933.结论 虽然性别、年龄、病程、血糖、血脂、血压等因素对ACR的预测能力有影响,但ACR对早期糖尿病肾病仍具有较好的预测能力,可以用作早期糖尿病肾病诊断指标;在使用ACR诊断早期糖尿病肾病时,应同时考虑代谢因素的影响.

abstractsObjective To analyze the correlation between urinary albumin/creatinine ratio (ACR) and 24-hour urinary microalbumin (UMA) and evaluate the predictive value of ARC for early diabetic nephropathy.Methods A total of 368 patients with type 2 diabetes mellitus were retrospectively collected.Early diabetic nephropathy was defined as 24h UMA 30～＜300 mg/24h.The correlation between ACR and 24hUMA,and the area under the receiver operating characteristic (ROC) curve of ACR in diagnosis of early diabetic nephropathy were calculated.Gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol were used as adjusting variables to establish univariate and multivariate logistic models of ACR for early diabetic nephropathy,respectively.A regression model was used to evaluate the diagnostic value of ACR for early diabetic nephropathy.Results The correlation between ACR and 24h UMA was 0.658.The area under ROC curve of ACR for early diabetic nephropathy was 0.907 before and 0.933 after adjustments of gender,age,course of disease,fasting venous blood glucose,glycosylated hemoglobin,blood pressure,triglyceride and total cholesterol,respectively.The OR value of ACR of diabetic nephropathy was 2.016 before and 2.762 after same adjustments.The calibration of Hosmer-Lemeshow chi-square test evaluation model was 19.362 before (P=0.13) and 14.928 after adjustments (P=0.061).Conclusion ACR is a better predictor for early diabetic nephropathy although its value is influenced by gender,age,course of disease,blood sugar,lipid,and blood pressure.