中国6省18~75岁人群微量白蛋白尿检出情况及影响因素

徐建伟; 刘敏; 王思琦; 李园; 张普洪; 白雅敏; 吉宁; 吴静

doi:10.16462/j.cnki.zhjbkz.2021.10.009

中国6省18~75岁人群微量白蛋白尿检出情况及影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.10.009

徐建伟¹,
刘敏¹,
王思琦¹,
李园²,
张普洪²,
白雅敏¹,
吉宁¹,
吴静^1, ,

1.
100050 北京，中国疾病预防控制中心慢性非传染性疾病预防控制中心
2.
100088 北京，北京大学医学部乔治健康研究所

基金项目:

英国国立健康研究院资助中英减盐项目 16/136/77

详细信息

通讯作者:
吴静，E-mail: wujing@ncncd.chinacdc.cn

中图分类号: R181.3
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出版历程
- 收稿日期: 2020-11-01
- 修回日期: 2021-01-28
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-10-10

Prevalence and influencing factors of microalbuminuria among general population aged from 18 to 75 years old in 6 provinces of China

1.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
2.
The George Institute for Global Health at Peking University Health Science Center, Beijing 100088, China

Funds:

National Institute for Health Research Global Health Research Unit Action on Salt China 16/136/77

More Information

Corresponding author: WU Jing, E-mail: wujing@ncncd.chinacdc.cn

摘要

摘要: 目的了解中国6省18~75岁人群微量白蛋白尿(microalbuminuria，MAU)检出状况及其影响因素。方法本研究于2018年采用多阶段整群随机抽样的方法，从6个省12个县、区中抽取2 693名18~75岁调查对象进行问卷调查、体格测量和24 h尿液收集。采用单因素、多因素Logistic回归分析模型分析相关影响因素。结果最终纳入分析的2 607名研究对象中，共检出234名MAU患者，MAU的检出率为8.98%(95% CI: 7.91%~10.14%)。男性、50岁及以上、吸烟、肥胖、高血压和糖尿病人群的MAU检出率分别为10.48%、11.91%、10.94%、14.82%、16.85%和23.21%，高于相对应人群，组间差异有统计学意义(均有P＜0.05)。多因素Logistic回归分析模型分析结果显示，与无高血压、无糖尿病和体重正常人群相比，高血压患者(OR=2.843, 95% CI: 2.093~3.862)、糖尿病患者(OR=2.453, 95% CI: 1.626~3.702)和肥胖人群(OR=1.941, 95% CI: 1.338~2.815)发生MAU的风险较高(均有P＜0.001)。结论高血压、糖尿病和肥胖与MAU的发生有关，应重视这些人群的MAU早期筛查，以预防和延缓肾脏损伤的发生发展。
- 白蛋白尿 /
- 危险因素 /
- 24小时尿
Abstract: Objective To investigate the prevalence and influencing factors of microalbuminuria (MAU) among a general Chinese population aged from 18 to 75 years old in 6 Provinces of China. Methods The multi-stage stratified cluster random sampling method was used in this study in 2018. A total 2 693 18-75-year-old subjects were selected from 12 districts of 6 Provinces. Questionnaire survey, physical measurement and 24 h urine collection were conducted. Univariate and multivariate Logistic regression analysis were used. Results A total of2 607 subjects were finally included in the analysis, a total of 234 MAU were detected and the detection rate of MAU was 8.98%(95% CI: 7.91%~10.14%). The detection rate of MAU in male, 50 years and above, smoking, obesity, hypertension and diabetes population were 10.48%、11.91%、10.94%、14.82%、16.85%、23.21%, respectively, which were significantly higher than the corresponding population (all P < 0.05). Compared with non-hypertension, non-diabetes, normal body weight people, hypertension(OR=2.843, 95% CI: 2.093~3.862, P < 0.001), diabetes(OR=2.453, 95% CI: 1.626~3.702, P < 0.001)and obesity(OR=1.941, 95%CI: 1.338~2.815, P < 0.001)would increase the risk of MAU. Conclusions Hypertension, diabetes and obesity were related to the occurrence of MAU. Early MAU screening should be carried out in these population, so as to prevent and delay the occurrence and development of kidney damage.
- Albuminuria /
- Risk factors /
- 24-Hour urine

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表 1 研究对象的基本情况(x±s)

Table 1. Baseline characteristics of participants (x±s)

变量	总体	MAU组	非MAU组	t值	P值
例数[n(%)]	2 607(100.00)	234(8.98)	2 373(91.02)
年龄(岁)	47.34±12.79	51.32±12.10	46.94±12.79	-5.02	＜0.001
身高(cm)	159.54±8.49	159.60±8.21	159.54±8.52	-0.11	0.911
体重(kg)	63.21±11.70	66.73±12.80	62.86±11.53	-4.45	＜0.001
BMI(kg/m²)	24.75±3.60	26.06±3.70	24.62±3.57	-5.85	＜0.001
腰围(cm)	83.99±17.93	87.97±10.25	83.60±18.47	-5.67	＜0.001
SBP(mm Hg)	126.17±19.13	138.67±21.33	124.94±18.46	-9.50	＜0.001
DBP(mm Hg)	79.43±11.53	85.62±13.02	78.82±11.19	-7.72	＜0.001
尿量(ml/d)	1 613.95±645.35	1 606.94±616.49	1 614.64±648.24	0.17	0.862
尿肌酐(mmol/d)	10.71±3.33	11.08±3.39	10.67±3.32	-1.79	0.074

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表 2 不同特征人群MAU检出率的比较

Table 2. Comparison of detection rate of MAU among different groups

变量	人数(例)	MAU人数(例)	MAU检出率(%)	χ²值	P值
性别				7.06	0.008
男	1 288	135	10.48
女	1 319	99	7.51
年龄(岁)				20.87	＜0.001
＜50	1 482	100	6.75
≥50	1 125	134	11.91
吸烟				5.22	0.022
否	1 830	149	8.14
是	777	85	10.94
饮酒				0.71	0.701
否	1 536	132	8.59
偶尔饮酒	821	79	9.62
经常饮酒	250	23	9.20
经常锻炼				0.91	0.339
否	1 558	133	8.54
是	1 049	101	9.63
BMI				30.77	＜0.001
正常	1 156	71	6.14
超重	999	96	9.61
肥胖	452	67	14.82
高血压				93.46	＜0.001
否	1 770	93	5.25
是	837	141	16.85
糖尿病				44.56	＜0.001
否	2 439	195	8.00
是	168	39	23.21

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表 3 多因素分析变量赋值

Table 3. Variable assignment of multivariate analysis

变量	赋值
MAU	0=否，1=是
年龄	0=＜50岁，1=≥50岁
性别	0=男，1=女
吸烟	0=不吸烟，1=吸烟
饮酒	0=不饮酒，1=偶尔饮酒，2=经常饮酒
经常锻炼	0=否，1=是
BMI	0=正常，1=超重，3=肥胖
高血压	0=否，1=是
糖尿病	0=否，1=是

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表 4 MAU相关影响因素的多因素分析

Table 4. Multivariate analysis on the influencing factors of MAU

变量	β值	$ {s_{\bar x}}$值	Wald χ²值	P值	OR(95%CI)值
BMI
正常					1.000
超重	-0.058	0.096	0.362	0.547	1.277(0.916~1.781)
肥胖	0.361	0.108	11.111	＜0.001	1.941(1.338~2.815)
高血压
否					1.000
是	1.045	0.156	44.746	＜0.001	2.843(2.093~3.862)
糖尿病
否					1.000
是	0.897	0.210	18.283	＜0.001	2.453(1.626~3.702)

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参考文献(20)

[1]	孙宁玲, 郭晓蕙, 林善锬, 等. 高血压与糖尿病患者微量白蛋白尿的筛查干预中国专家共识[J]. 中华高血压杂志, 2012, 20(5): 423-428. DOI: 10.16439/j.cnki.1673-7245.2012.05.008. Sun NL, Guo XH, Lin ST, et al. Chinese expert consensus on the screening intervention of microalbuminuria in hypertension and diabetes patients[J]. Chin J Hypertens, 2012, 20(5): 423-428. DOI: 10.16439/j.cnki.1673-7245.2012.05.008.
[2]	Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde M, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis[J]. Lancet, 2010, 375(9731): 2073-2081. DOI: 10.1016/S0140-6736(10)60674-5.
[3]	Marshall SM. Screening for microalbuminuria: which measurement?[J]. Diabet Med, 1991, 8(8): 706-711. DOI: 10.1111/j.1464-5491.1991.tb01688.x.
[4]	Yan LX, Ma JX, Guo XL, et al. Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study[J]. BMC Nephrol, 2014, 15: 165. DOI: 10.1186/1471-2369-15-165.
[5]	Xu JW, Ma JX, Chen XR, et al. Association of microalbuminuria and high-normal 24-hour urinary albumin excretion with metabolic syndrome and its components in the general Chinese population: cross-sectional study[J]. BMJ Open, 2019, 9(11): e031443. DOI: 10.1136/bmjopen-2019-031443.
[6]	Xu JW, Tang BW, Liu M, et al. A town level comprehensive intervention study to reduce salt intake in China: protocol for a cluster randomised controlled trial[J]. BMJ Open, 2020, 10(1): e032976. DOI: 10.1136/bmjopen-2019-032976.
[7]	中国肥胖问题工作组数据汇总分析协作组. 我国成人体重指数和腰围对相关疾病危险因素异常的预测价值: 适宜体重指数和腰围切点的研究[J]. 中华流行病学杂志, 2002, 23(1): 5-10. DOI: 10.3760/j.issn:0254-6450.2002.01.003. Cooperative meta-analysis group of China obesity task force. Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population[J]. Chin J Epidemiol, 2002, 23(1): 5-10. DOI: 10.3760/j.issn:0254-6450.2002.01.003.
[8]	国家卫生计生委疾病预防控制局. 中国居民营养与慢性病状况报告[M]. 北京: 人民卫生出版社, 2015. Disease Prevention and Control Bureau of National Health and Family Planning Commission of the People's Republic of China. Report on Chinese residents' chronic disease and nutrition[M]. Beijing: People's Medical Publishing House, 2015.
[9]	《中国高血压基层管理指南》修订委员会. 中国高血压基层管理指南(2014年修订版)[J]. 中华健康管理学杂志, 2015, 9(1): 10-30. DOI: 10.3760/cma.j.issn.1674-0815.2015.01.004. Revision Committee of Chinese Guidelines for the Management of Hypertension. Chinese guidelines for the management of hypertension (revised 2014)[J]. Chin J Heal Manag, 2015, 9(1): 10-30. DOI: 10.3760/cma.j.issn.1674-0815.2015.01.004.
[10]	Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Ann Intern Med. 2003, 139(2): 137-147. DOI: 10.7326/0003-4819-139-2-200307150-00013.
[11]	Li Y, Zhang PH, Wu J, et al. Twenty-four-hour urinary sodium and potassium excretion and their associations with blood pressure among adults in China: baseline survey of action on salt China[J]. Hypertension, 2020, 76(5): 1580-1588. DOI: 10.1161/hypertensionaha.120.15238.
[12]	Chen BD, Yang DG, Chen Y, et al. The prevalence of microalbuminuria and its relationships with the components of metabolic syndrome in the general population of China[J]. Clin Chim Acta, 2010, 411(9-10): 705-709. DOI: 10.1016/j.cca.2010.01.038.
[13]	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. DOI: 10.1016/s0140-6736(12)60033-6.
[14]	Sheng CS, Hu BC, Fan WX, et al. Microalbuminuria in relation to the metabolic syndrome and its components in a Chinese population[J]. Diabetol Metab Syndr, 2011, 3(1): 6. DOI: 10.1186/1758-5996-3-6.
[15]	Hao G, Wang ZW, Zhang LF, et al. Prevalence of microalbuminuria among middle-aged population of China: a multiple center cardiovascular epidemiological study[J]. Angiology, 2015, 66(1): 49-56. DOI: 10.1177/0003319713513144.
[16]	徐建伟, 马吉祥, 陈晓荣, 等. 普通人群微量白蛋白尿与心血管疾病危险因素的关系[J]. 中华肾脏病杂志, 2019, 35(1): 30-35. DOI: 10.3760/cma.j.issn.1001-7097.2019.01.005. Xu JW, Ma JX, Chen XR, et al. Association between microalbuminuria and cardiovascular risk factors in general population[J]. Chin J Nephrol, 2019, 35(1): 30-35. DOI: 10.3760/cma.j.issn.1001-7097.2019.01.005.
[17]	Ge Z, Guo XL, Chen XR, et al. Are microalbuminuria and elevated 24 h urinary microalbumin excretion within normal range associated with metabolic syndrome in Chinese adults?[J]. PLoS One, 2015, 10(9): e0138410. DOI: 10.1371/journal.pone.0138410.
[18]	Munakata M, Konno S, Ohshima M, et al. High-normal blood pressure is associated with microalbuminuria in the general population: the Watari study[J]. Hypertens Res, 2011, 34(10): 1135-1140. DOI: 10.1038/hr.2011.98.
[19]	Böhm M, Thoenes M, Danchin N, et al. Association of cardiovascular risk factors with microalbuminuria in hypertensive individuals: the i-SEARCH global study[J]. J Hypertens, 2007, 25(11): 2317-2324. DOI: 10.1097/hjh.0b013e3282ef1c5f.
[20]	Seo WJ, Lee GM, Hwang JH, et al. Association between body mass index, waist circumference and prevalence of microalbuminuria in Korean adults of age 30 years and older without diabetes, hypertension, renal failure, or overt proteinuria: the 2013 Korean national health and nutrition examination survey[J]. Korean J Fam Med, 2016, 37(1): 57-63. DOI: 10.4082/kjfm.2016.37.1.57.