Division of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2013 Mar;28(3):409-14. doi: 10.3346/jkms.2013.28.3.409. Epub 2013 Mar 4.
We aimed to investigate the significance of microalbuminuria and its relationship with subclinical atherosclerosis in nonhypertensive and nondiabetic patients, by using coronary artery computed tomography (CT). A total of 1,318 nonhypertensive and nondiabetic subjects who had taken coronary artery CT and measured spot urine albumin to creatinine ratio (UACR) were evaluated. The atherosclerotic changes of coronary arteries were greater in subjects with microalbuminuria, reflected by coronary artery calcium score (CACS) and significant coronary artery stenosis (CACS ≥ 100 in 15.3% vs 7.6% and stenosis ≥ 50% in 11.5% vs 4.9% of patients with vs without microalbuminuria, P = 0.008 and P = 0.011, respectively). Among various parameters that are known as a risk factor or possible biomarkers of coronary artery disease, presence of microalbuminuria, age and Framingham risk score were significantly related to coronary artery stenosis. Among them the presence of microalbuminuria showed stronger correlation than others to the coronary artery stenosis detected by CT, even after adjusting confounding factors (OR 3.397, 95% confidence interval 1.138 to 10.140, P = 0.028). The presence of microalbuminuria by UACR was significantly associated with presence of coronary artery stenosis ≥ 50% in asymptomatic, nonhypertensive and nondiabetic general population. Our study suggests that the presence of microalbuminuria may imply subclinical coronary artery disease, even in asymptomatic population.
我们旨在通过冠状动脉计算机断层扫描（CT）研究非高血压和非糖尿病患者微量白蛋白尿的意义及其与亚临床动脉粥样硬化的关系。共评估了 1318 例接受冠状动脉 CT 检查并测量了尿白蛋白与肌酐比值（UACR）的非高血压和非糖尿病患者。微量白蛋白尿患者的冠状动脉粥样硬化变化更大，表现为冠状动脉钙评分（CACS）和显著冠状动脉狭窄（CACS≥100 的患者分别为 15.3%比 7.6%和狭窄≥50%的患者分别为 11.5%比 4.9%，P=0.008 和 P=0.011）。在已知的冠状动脉疾病风险因素或可能的生物标志物中，微量白蛋白尿的存在、年龄和弗莱明翰风险评分与冠状动脉狭窄显著相关。其中，微量白蛋白尿的存在与 CT 检测到的冠状动脉狭窄相关性更强，即使在调整混杂因素后也是如此（OR 3.397，95%置信区间 1.138 至 10.140，P=0.028）。UACR 中微量白蛋白尿的存在与无症状、非高血压和非糖尿病普通人群中≥50%的冠状动脉狭窄显著相关。我们的研究表明，即使在无症状人群中，微量白蛋白尿的存在也可能暗示亚临床冠状动脉疾病。
