颈动脉内膜中层厚度与动脉粥样硬化多民族研究（MESA）中尿白蛋白/肌酐比值进展的关系。

Association of carotid intima-media thickness with progression of urine albumin-creatinine ratios in The Multi-Ethnic Study of Atherosclerosis (MESA).

机构信息

Oncology Institute, Loyola University Medical Center, Maywood, IL 60153, USA.

出版信息

Am J Kidney Dis. 2011 Jan;57(1):62-70. doi: 10.1053/j.ajkd.2010.08.014. Epub 2010 Oct 25.

DOI:10.1053/j.ajkd.2010.08.014

PMID:20974513

Abstract

BACKGROUND

The association between measures of subclinical cardiovascular disease and progression of urine albumin-creatinine ratios (UACRs) over time is uncertain.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS: The Multi-Ethnic Study of Atherosclerosis (MESA), a cohort of adults aged 45-84 years without baseline clinical cardiovascular disease. Examinations were completed approximately every 1.5 years, and UACR was measured during the first 3 examinations. Analysis was limited to 4,878 participants without baseline micro- or macroalbuminuria.

PREDICTOR

1-standard deviation (SD) unit difference in baseline maximum common and internal carotid intima-media thickness (CIMT) measured using ultrasonography.

OUTCOMES & MEASUREMENTS: Baseline UACR was categorized as normal or high-normal. UACR progression was categorized as no progression (consistent UACR category across all 3 examinations or regression to a lower category) and definite progression (higher UACR category at examination 2 compared with baseline, then stabilizing or progressing at examination 3). UACR changes not consistent with definite or no UACR progression were classified as intermediate UACR progression. Change in log UACR also was examined.

RESULTS

In the 4,878 participants, median baseline UACR was 4.6 mg/g (range, 0.4-24.6 mg/g). Definite and intermediate UACR progression was noted in 279 and 807, respectively. Every 1-SD unit difference in common CIMT was associated with a 22% increased adjusted odds of definite compared with no UACR progression (95% CI, 1.07-1.41). No significant association was noted between 1-SD unit difference in maximum internal CIMT and definite UACR progression after adjusting for covariates (OR, 1.08; 95% CI, 0.96-1.21). In the mixed-effects model, changes in log UACR were 0.029 (95% CI, 0.012-0.046) and 0.019 mg/g (95% CI, 0.001-0.037) per 1-SD difference in maximum common and internal CIMT after adjustment for covariates, respectively.

LIMITATIONS

UACR was measured in a single spot urine specimen at each exam.

CONCLUSION

Higher common CIMT is associated with UACR progression.

摘要

背景

亚临床心血管疾病的测量指标与尿白蛋白肌酐比值（UACR）随时间的进展之间的关系尚不确定。

研究设计

前瞻性队列研究。

研究地点和参与者

动脉粥样硬化多民族研究（MESA），一组年龄在 45-84 岁之间、基线时无临床心血管疾病的成年人。检查大约每 1.5 年进行一次，并且在最初的 3 次检查中测量 UACR。分析仅限于基线时无微白蛋白尿或大量白蛋白尿的 4878 名参与者。

预测指标

使用超声测量的基线最大颈总动脉和颈内动脉内膜中层厚度（CIMT）的 1 个标准差（SD）单位差异。

研究结果

在 4878 名参与者中，中位基线 UACR 为 4.6mg/g（范围，0.4-24.6mg/g）。分别有 279 名和 807 名参与者出现明确和中等程度的 UACR 进展。与无 UACR 进展相比，普通 CIMT 每增加 1 个 SD，经调整后的明确 UACR 进展的优势比为 1.21（95%CI，1.07-1.41）。在调整了协变量后，最大内部 CIMT 的 1-SD 单位差异与明确的 UACR 进展之间没有显著关联（OR，1.08；95%CI，0.96-1.21）。在混合效应模型中，经协变量调整后，最大颈总动脉和颈内动脉内膜中层厚度每增加 1 个 SD，log UACR 的变化分别为 0.029（95%CI，0.012-0.046）和 0.019mg/g（95%CI，0.001-0.037）。