Mattix Holly J, Hsu Chi-Yuan, Shaykevich Shimon, Curhan Gary
*Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Division of Nephrology, University of California, San Francisco, California; and Department of Medicine and Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts.
J Am Soc Nephrol. 2002 Apr;13(4):1034-1039. doi: 10.1681/ASN.V1341034.
The recommended albumin (microg)/creatinine (mg) ratio (ACR) (30 microg/mg) to detect microalbuminuria does not account for sex or racial differences in creatinine excretion. In a nationally representative sample of subjects, the distribution of urine albumin and creatinine concentrations was examined by using one ACR value (> or =30 microg/mg) and sex-specific cutpoints (> or =17 microg/mg in men and > or =25 microg/mg in women) measured in spot urine specimens. Mean urine albumin concentrations were not significantly different between men and women, but urine creatinine concentrations were significantly higher (P < 0.0001). Compared with non-Hispanic whites, urine creatinine concentrations were significantly higher in non-Hispanic blacks (NHB) and Mexican Americans, whereas urine albumin concentrations were significantly higher in NHB (P < 0.0001) but not Mexican Americans. When a single ACR is used, the prevalence of microalbuminuria was significantly lower among the men compared with women (6.0 versus 9.2%; P < 0.0001) and among non-Hispanic whites compared with NHB (7.2 versus 10.2%; P < 0.0001). No significant difference in the prevalence of microalbuminuria between men and women was noted when sex-specific ACR cutpoints were used. In the multivariate adjusted model, female sex (odds ratio, 1.62; 95% confidence interval, 1.29 to 2.05) and NHB race/ethnicity (odds ratio, 1.34; 95% confidence interval, 1.12 to 1.61) were independently associated with microalbuminuria when a single ACR threshold was used. When a sex-specific ACR was used, NHB race/ethnicity remained significantly associated with microalbuminuria but sex did not. The use of one ACR value to define microalbuminuria may underestimate microalbuminuria in subjects with higher muscle mass (men) and possibly members of certain racial/ethnic groups.
用于检测微量白蛋白尿的推荐白蛋白（微克）/肌酐（毫克）比值（ACR）（30微克/毫克）未考虑肌酐排泄方面的性别或种族差异。在一项具有全国代表性的受试者样本中，通过使用一个ACR值（≥30微克/毫克）以及在随机尿标本中测得的性别特异性切点（男性≥17微克/毫克，女性≥25微克/毫克）来检查尿白蛋白和肌酐浓度的分布。男性和女性的平均尿白蛋白浓度无显著差异，但尿肌酐浓度显著更高（P<0.0001）。与非西班牙裔白人相比，非西班牙裔黑人（NHB）和墨西哥裔美国人的尿肌酐浓度显著更高，而NHB的尿白蛋白浓度显著更高（P<0.0001），但墨西哥裔美国人并非如此。当使用单一ACR时，男性中微量白蛋白尿的患病率显著低于女性（6.0%对9.2%；P<0.0001），非西班牙裔白人中显著低于NHB（7.2%对10.2%；P<0.0001）。当使用性别特异性ACR切点时，未发现男性和女性之间微量白蛋白尿患病率有显著差异。在多变量调整模型中，当使用单一ACR阈值时，女性性别（比值比，1.62；95%置信区间，1.29至2.05）和NHB种族/族裔（比值比，1.34；95%置信区间，1.12至1.61）与微量白蛋白尿独立相关。当使用性别特异性ACR时，NHB种族/族裔仍与微量白蛋白尿显著相关，但性别则不然。使用单一ACR值来定义微量白蛋白尿可能会低估肌肉量较高的受试者（男性）以及某些种族/族裔群体成员中的微量白蛋白尿。
