Stroke Center and Department of Neurology, University of California, Los Angeles, CA 90095, USA.
Stroke. 2010 Nov;41(11):2625-31. doi: 10.1161/STROKEAHA.110.581215. Epub 2010 Oct 7.
Microalbuminuria, a marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and magnitude of the link between microalbuminuria and incident stroke has not been clearly defined. The purpose of this study was to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective studies using meta-analysis.
We conducted a systematic search of electronic databases and bibliographies for studies reporting a multivariate-adjusted estimate, represented as relative risk with 95% CI, of the association between microalbuminuria and stroke risk. Studies were excluded if a majority of study participants had established kidney disease or pre-eclampsia. Estimates were combined using a random-effect model.
We identified 12 studies, with a total of 48 596 participants and 1263 stroke events. Overall, presence of microalbuminuria was associated with greater stroke risk (relative risk, 1.92; 95% CI, 1.61 to 2.28; P < 0.001) after adjustment for established cardiovascular risk factors. There was evidence of significant heterogeneity in the magnitude of the association across studies (P for heterogeneity < 0.001, I² = 68%), which was partially explained by differences in study population, microalbuminuria definition, and different microalbuminuria-related risk among stroke subtypes. However, in stratified analyses, microalbuminuria was associated with increased risk of subsequent stroke in all subgroups (general population, diabetics, those with known stroke).
Microalbuminuria is strongly and independently associated with incident stroke risk. Future studies should explore whether microalbuminuria is just a risk marker or a modifiable risk factor for stroke.
微量白蛋白尿是肾脏疾病和血管内皮功能障碍的标志物，可能与全身血管风险相关，但微量白蛋白尿与中风事件风险之间的关联性质和程度尚未明确。本研究旨在通过荟萃分析评估前瞻性研究中微量白蛋白尿与中风风险关联的一致性和强度。
我们对电子数据库和参考文献进行了系统检索，以查找报告多变量校正估计值（表示为相对风险和 95%置信区间）的研究，该估计值代表微量白蛋白尿与中风风险之间的关联。如果大多数研究参与者患有已确诊的肾脏疾病或先兆子痫，则排除研究。使用随机效应模型合并估计值。
我们确定了 12 项研究，共有 48596 名参与者和 1263 例中风事件。总体而言，微量白蛋白尿的存在与更高的中风风险相关（相对风险，1.92；95%置信区间，1.61 至 2.28；P < 0.001），校正已确立的心血管危险因素后。研究之间关联程度存在显著异质性（P 异质性< 0.001，I²=68%），这部分解释了研究人群、微量白蛋白尿定义以及中风亚型中不同的微量白蛋白尿相关风险之间的差异。然而，在分层分析中，微量白蛋白尿与所有亚组（普通人群、糖尿病患者、已知中风患者）的后续中风风险增加相关。
微量白蛋白尿与中风事件风险强烈且独立相关。未来的研究应该探讨微量白蛋白尿是否只是中风风险的标志物或可改变的风险因素。
