Division of Nephrology and Hypertension, Department of Medicine, University of California, San Diego, USA.
Clin J Am Soc Nephrol. 2012 Apr;7(4):595-603. doi: 10.2215/CJN.09300911. Epub 2012 Mar 1.
In the albumin-to-creatinine ratio (spot-ACR), urine creatinine corrects for tonicity but also reflects muscle mass. Low muscle mass is associated with cardiovascular disease (CVD). We hypothesized that the spot-ACR would be higher in women, lower-weight persons, and older individuals, independent of timed urine albumin excretion (24hr-UAE), and accordingly, that spot-ACR would be more strongly associated with CVD events than 24hr-UAE in these subgroups.
DESIGN, SETTING, PARTICIPANTS, & METHODS: 2627 PREVEND (Prevention of Renal and Vascular End-stage Disease) participants with 24hr-UAE <30 mg/d were followed for CVD events for 11 years. Cox regression evaluated associations of spot-ACR and 24hr-UAE with CVD events by sex, weight, and age.
Female sex (26%), lower weight (2% per 5 kg), and older age (4% per 5 years) were associated with higher spot-ACR independent of 24hr-UAE (P<0.001). Spot urine albumin concentration (hazard ratio [HR], 1.26 per ln-SD higher) and 1/spot urine creatinine concentration (HR, 1.16 per ln-SD higher) were associated with CVD events. Spot-ACR was more strongly associated with CVD events than either component of the ratio (HR, 1.41 per ln-SD higher). Associations of spot-ACR ≥10 mg/g versus less (HR, 2.33) and 24hr-UAE ≥10 mg/d versus less (HR, 2.09) with CVD events were similar, and there were no significant differences across subgroups (P for interactions >0.06).
In community-living individuals with 24hr-UAE <30 mg/d, spot-ACR is higher in women, older persons, and lower-weight persons, independent of 24hr-UAE. Low spot urine creatinine is associated with CVD risk, but high urine albumin is a stronger determinant of the association of spot-ACR with CVD than is low urine creatinine.
在白蛋白/肌酐比值（spot-ACR）中，尿液肌酐校正了渗透压，但也反映了肌肉量。肌肉量低与心血管疾病（CVD）有关。我们假设，无论 24 小时尿白蛋白排泄量（24hr-UAE）如何，spot-ACR 在女性、体重较轻和年龄较大的个体中更高，因此，在这些亚组中，spot-ACR 与 CVD 事件的相关性将强于 24hr-UAE。
设计、地点、参与者和方法：2627 名 PREVEND（预防肾脏和血管终末期疾病）参与者的 24hr-UAE<30mg/d，随访 11 年以观察 CVD 事件。Cox 回归评估了 spot-ACR 和 24hr-UAE 与 CVD 事件的相关性，按性别、体重和年龄进行分层。
女性（26%）、体重较轻（每 5kg 体重减轻 2%）和年龄较大（每 5 岁年龄增加 4%）与独立于 24hr-UAE 的 spot-ACR 升高有关（P<0.001）。尿液白蛋白浓度（风险比[HR]，每增加一个自然对数标准差[ln-SD]升高 1.26）和尿液肌酐浓度（HR，每增加一个 ln-SD 升高 1.16）与 CVD 事件相关。与比值的任何一个组成部分相比，spot-ACR 与 CVD 事件的相关性更强（HR，每增加一个 ln-SD 升高 1.41）。spot-ACR≥10mg/g 与<10mg/g（HR，2.33）和 24hr-UAE≥10mg/d 与<10mg/d（HR，2.09）与 CVD 事件的相关性相似，并且各亚组之间无显著差异（P 值>0.06）。
在 24hr-UAE<30mg/d 的社区居住者中，spot-ACR 在女性、年龄较大和体重较轻的个体中更高，独立于 24hr-UAE。尿液肌酐浓度低与 CVD 风险相关，但尿液白蛋白浓度高是 spot-ACR 与 CVD 相关性的决定因素，其作用强于尿液肌酐浓度低。
