尿白蛋白与肌酐比值：青少年早期内皮功能障碍的一个标志物。

Urine Albumin-to-Creatinine Ratio: A Marker of Early Endothelial Dysfunction in Youth.

作者信息

Bartz Sara Klinepeter, Caldas Maria C, Tomsa Anca, Krishnamurthy Ramkumar, Bacha Fida

机构信息

Children's Nutrition Research Center (S.K.B., M.C.C., A.T., F.B.), Baylor College of Medicine, Houston, Texas 77030; and Division of Pediatric Diabetes and Endocrinology (S.K.B., M.C.C., A.T., F.B.) and Department of Radiology, (R.K.), Texas Children's Hospital, Houston, Texas 77030.

出版信息

J Clin Endocrinol Metab. 2015 Sep;100(9):3393-9. doi: 10.1210/JC.2015-2230. Epub 2015 Jul 15.

DOI:10.1210/JC.2015-2230

PMID:26176802

Abstract

CONTEXT

The urine albumin-to-creatinine ratio (UACR) is a useful predictor of cardiovascular (CV) events in adults. Its relationship to vascular function in children is not clear.

OBJECTIVE

We investigated whether UACR was related to insulin resistance and endothelial function, a marker of subclinical atherosclerosis, in adolescents across the spectrum of glucose regulation.

PARTICIPANTS

Participants were 58 adolescents: 13 normal weight (NW), 25 overweight with normal glucose tolerance (OW-NGT), and 20 overweight with prediabetes (OW-PreD).

INTERVENTIONS

Interventions included oral glucose tolerance test, hyperinsulinemic-euglycemic clamp with determination of insulin sensitivity (IS), endothelial function assessment by peripheral arterial tonometry determination of the reactive hyperemia index (RHI), body composition (dual-energy x-ray absorptiometry), and abdominal fat distribution (magnetic resonance imaging).

PRIMARY OUTCOME MEASURE

Fasting UACR was determined.

RESULTS

The 3 groups did not differ with respect to age, sex, or Tanner stage. The NW group had significantly lower percent body fat, higher IS (10.4 ± 0.9, 3.5 ± 0.6, and 2.1 ± 0.2 mg/kg/min per μU/mL; P < .001), and higher RHI (1.84 ± 0.1, 1.56 ± 0.1, and 1.56 ± 0.1, P = .04) than the OW-NGT and OW-PreD groups, respectively. lnUACR was related to percent body fat (r = 0.4, P = .001), RHI (r = -0.33, p = .01), and IS (r = -0.27, P = .043). In multiple regression analysis with lnUACR as the dependent variable and RHI, percent body fat, age, sex, race, systolic blood pressure, cholesterol, glycated hemoglobin, and IS as independent variables, RHI (β = -0.3, P = .045) and sex (β = 0.31, P = .06) contributed to the variance in UACR (R(2) = 0.35, P = .02).

CONCLUSIONS

UACR is an early marker of endothelial dysfunction in youth, independent of glycemia. Endothelial dysfunction may mediate the link between obesity-related insulin resistance and early microalbuminuria.

摘要

背景

尿白蛋白与肌酐比值（UACR）是成人心血管（CV）事件的有用预测指标。其与儿童血管功能的关系尚不清楚。

目的

我们研究了在整个血糖调节范围内，青少年的UACR是否与胰岛素抵抗和内皮功能（亚临床动脉粥样硬化的一个标志物）相关。

参与者

参与者为58名青少年：13名体重正常（NW），25名超重且糖耐量正常（OW-NGT），以及20名超重且有糖尿病前期（OW-PreD）。

干预措施

干预措施包括口服葡萄糖耐量试验、高胰岛素-正常血糖钳夹试验以测定胰岛素敏感性（IS）、通过外周动脉张力测定反应性充血指数（RHI）评估内皮功能、身体成分分析（双能X线吸收法）以及腹部脂肪分布分析（磁共振成像）。

主要观察指标

测定空腹UACR。

结果

三组在年龄、性别或坦纳分期方面无差异。NW组的体脂百分比显著更低，胰岛素敏感性更高（分别为10.4±0.9、3.5±0.6和2.1±0.2mg/kg/min每μU/mL；P<.001），并且反应性充血指数高于OW-NGT组和OW-PreD组（分别为1.84±0.1、1.56±0.1和1.56±0.1，P=.04）。对数UACR与体脂百分比（r = 0.4，P =.001）、反应性充血指数（r = -0.33，P =.01）和胰岛素敏感性（r = -0.27，P =.043）相关。在以对数UACR作为因变量，反应性充血指数、体脂百分比、年龄、性别、种族、收缩压、胆固醇、糖化血红蛋白和胰岛素敏感性作为自变量的多元回归分析中，反应性充血指数（β = -0.3，P =.045）和性别（β = 0.31，P =.06）对UACR的方差有贡献（R(2)=0.35，P =.02）。