Nguyen Stephanie, McCulloch Charles, Brakeman Paul, Portale Anthony, Hsu Chi-yuan
Department of Pediatrics, University of California, San Francisco, California, USA.
Pediatrics. 2008 Jan;121(1):37-45. doi: 10.1542/peds.2007-3594.
The goal was to determine the association between cardiovascular risk factors and microalbuminuria in a nationally representative sample of adolescents and to determine whether being overweight modifies this association.
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (1999-2004) for 2515 adolescents 12 to 19 years of age. Cardiovascular risk factors included abdominal obesity, impaired fasting glucose, diabetes mellitus, insulin resistance, high triglyceride levels, low high-density lipoprotein cholesterol levels, hypertension, smoking, and the metabolic syndrome. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 30 to 299 mg/g in a random morning sample. Overweight was defined as BMI of > or = 95th percentile, according to the Centers for Disease Control and Prevention 2000 growth charts.
Microalbuminuria was present in 8.9% of adolescents. The prevalence of microalbuminuria was higher among nonoverweight adolescents than among overweight adolescents. The median albumin/creatinine ratio decreased with increasing BMI z scores. The association of microalbuminuria with cardiovascular risk factors differed according to BMI category. Among nonoverweight adolescents, microalbuminuria was not associated with any cardiovascular disease risk factor except for overt diabetes mellitus. Among overweight adolescents, however, microalbuminuria was associated with impaired fasting glucose, insulin resistance, hypertension, and smoking, as well as diabetes mellitus.
For the majority of adolescents, microalbuminuria is not associated with cardiovascular risk factors. Among overweight adolescents, however, microalbuminuria is associated with cardiovascular risk factors. The prognostic importance of microalbuminuria in overweight and nonoverweight adolescents with regard to future cardiovascular and renal disease needs to be defined in prospective studies conducted specifically in children.
本研究旨在确定全国具有代表性的青少年样本中心血管危险因素与微量白蛋白尿之间的关联，并确定超重是否会改变这种关联。
我们分析了来自国家健康与营养检查调查（1999 - 2004年）的2515名12至19岁青少年的横断面数据。心血管危险因素包括腹型肥胖、空腹血糖受损、糖尿病、胰岛素抵抗、高甘油三酯水平、低高密度脂蛋白胆固醇水平、高血压、吸烟以及代谢综合征。微量白蛋白尿定义为随机晨尿样本中尿白蛋白/肌酐比值为30至299mg/g。根据疾病控制与预防中心2000年生长图表，超重定义为BMI大于或等于第95百分位数。
8.9%的青少年存在微量白蛋白尿。非超重青少年中微量白蛋白尿的患病率高于超重青少年。白蛋白/肌酐比值中位数随BMI z评分增加而降低。微量白蛋白尿与心血管危险因素的关联因BMI类别而异。在非超重青少年中，微量白蛋白尿除了与显性糖尿病外，与任何心血管疾病危险因素均无关联。然而，在超重青少年中，微量白蛋白尿与空腹血糖受损、胰岛素抵抗、高血压、吸烟以及糖尿病有关。
对于大多数青少年来说，微量白蛋白尿与心血管危险因素无关。然而，在超重青少年中，微量白蛋白尿与心血管危险因素有关。微量白蛋白尿在超重和非超重青少年中对于未来心血管和肾脏疾病的预后重要性需要在专门针对儿童进行的前瞻性研究中加以明确。
