Rowley K G, Iser D M, Best J D, O'Dea K, Leonard D, McDermott R
The University of Melbourne, Department of Medicine, St Vincent's Hospital, Fitzroy, VIC, Australia.
Diabetologia. 2000 Nov;43(11):1397-403. doi: 10.1007/s001250051545.
AIMS/HYPOTHESIS: To examine the prevalence and associations with the metabolic syndrome of albuminuria among Australian Aboriginal people.
Early-morning urine specimens were collected as part of community-based risk factor surveys assessing the prevalence of diabetes and cardiovascular disease in eight remote communities, with a sample size of 1,075 people. Microalbuminuria was defined as urinary albumin : creatinine ratio 3.4-33.9 mg/mmol, macroalbuminuria as albumin: creatinine ratio equal to or greater than 34 mg/mmol.
There were high prevalences of microalbuminuria (men 22.2 %, women 26.9 %) and of macroalbuminuria (men 10.4%, women 13.5%). There were highly statistically significant linear associations of microalbuminuria and macroalbuminuria with increasing number of coexisting components of the metabolic syndrome (hypertension, glucose intolerance, dyslipidaemia, insulin resistance, abdominal obesity): among people with zero, one, two and three to five of these conditions, respectively, prevalence of microalbuminuria was 16%, 20%, 36% and 32% (p < 0.001); prevalence of macroalbuminuria was 2%, 6%, 12% and 32% (p < 0.001). There were independent associations of microalbuminuria with hypertension (odds ratio, 95% confidence interval = 2.36, 1.63-3.42) and diabetes (2.10, 1.28-3.45): macroalbuminuria was independently associated with hypertension (6.39, 3.93-10.4), diabetes (3.49, 1.93-6.28) and abdominal obesity (4.56, 2.40-8.64) and had a weaker association with insulin resistance (1.99, 1.12-3.54). Dyslipidaemia and impaired glucose tolerance were neither independently associated with microalbuminuria or macroalbuminuria, nor was insulin resistance or abdominal obesity independently associated with microalbuminuria.
CONCLUSION/INTERPRETATION: There was a strong clustering of albuminuria with components of the metabolic syndrome. Diabetes, hypertension and abdominal obesity are major contributors to high rates of albuminuria among Australian Aboriginal people.
目的/假设：研究澳大利亚原住民中蛋白尿的患病率及其与代谢综合征的关联。
作为基于社区的危险因素调查的一部分，收集了八个偏远社区1075人的清晨尿液样本，以评估糖尿病和心血管疾病的患病率。微量白蛋白尿定义为尿白蛋白：肌酐比值为3.4 - 33.9mg/mmol，大量白蛋白尿定义为白蛋白：肌酐比值等于或大于34mg/mmol。
微量白蛋白尿（男性22.2%，女性26.9%）和大量白蛋白尿（男性10.4%，女性13.5%）的患病率都很高。微量白蛋白尿和大量白蛋白尿与代谢综合征并存成分（高血压、糖耐量异常、血脂异常、胰岛素抵抗、腹型肥胖）数量增加之间存在高度统计学意义的线性关联：在分别有零种、一种、两种以及三种至五种这些情况的人群中，微量白蛋白尿的患病率分别为16%、20%、36%和32%（p < 0.001）；大量白蛋白尿的患病率分别为2%、6%、12%和32%（p < 0.001）。微量白蛋白尿与高血压（比值比，95%置信区间 = 2.36，1.63 - 3.42）和糖尿病（2.10，1.28 - 3.45）存在独立关联：大量白蛋白尿与高血压（6.39，3.93 - 10.4）、糖尿病（3.49，1.93 - 6.28）和腹型肥胖（4.56，2.40 - 8.64）独立相关，与胰岛素抵抗（1.99，1.12 - 3.54）的关联较弱。血脂异常和糖耐量受损既不与微量白蛋白尿也不与大量白蛋白尿独立相关，胰岛素抵抗或腹型肥胖也不与微量白蛋白尿独立相关。
结论/解读：蛋白尿与代谢综合征的成分之间存在强烈的聚集现象。糖尿病、高血压和腹型肥胖是澳大利亚原住民中蛋白尿高发生率的主要促成因素。
