Arai Riku, Suzuki Shinya, Kano Hiroto, Semba Hiroaki, Arita Takuto, Yagi Naoharu, Otsuka Takayuki, Matsuno Shunsuke, Matsuhama Minoru, Kato Yuko, Uejima Tokuhisa, Oikawa Yuji, Okumura Yasuo, Yajima Junji, Yamashita Takeshi
Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 1060031, Japan.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Heart Vessels. 2020 Sep;35(9):1256-1269. doi: 10.1007/s00380-020-01596-y. Epub 2020 Apr 4.
Initial screening for proteinuria by urine dipstick test (UDT) may be useful for predicting clinical outcomes. The Shinken Database includes all the new patients visiting the Cardiovascular Institute Hospital in Tokyo, Japan. Patients for whom UDT was performed at their initial visit between 2004 and 2010 (n = 7131) were divided into three groups according to the test results: negative, trace, and positive (1+ to 4+) proteinuria. During the mean follow-up period of 3.4 years, 233 (3.1%) deaths, 255 (3.6%) heart failure (HF) events, and 106 (1.5%) ischemic stroke (IS) events occurred. Prevalence of atherothrombotic risks increased with an increase in the amounts of proteinuria. The incidence of all-cause death, HF and IS events increased significantly from negative to trace to positive proteinuria groups (log rank test, P for trend < 0.001). Multivariate analysis revealed independent association between proteinuria and all-cause death [hazard ratio (HR): 1.50, 95% confidence interval (CI) 1.07-2.10], HF (HR: 1.55, 95% CI 1.14-2.12), and IS (HR: 2.08, 95% CI 1.26-3.45). Even trace proteinuria was independently associated with HF (HR: 1.64, 95% CI 1.07-2.53) and IS (HR: 2.17, 95% CI 1.14-4.11) and with all-cause death (HR: 1.56, 95% CI 0.99-2.47). In conclusions, dipstick proteinuria was independently associated with cardiovascular events and death, suggesting that the UDT is a useful tool for evaluating patients' risk for such adverse events.
通过尿试纸条试验（UDT）进行蛋白尿的初步筛查可能有助于预测临床结局。新田数据库包含了所有前往日本东京心血管研究所医院就诊的新患者。在2004年至2010年期间首次就诊时进行了UDT的患者（n = 7131）根据检测结果被分为三组：蛋白尿阴性、微量和阳性（1+至4+）。在平均3.4年的随访期内，发生了233例（3.1%）死亡、255例（3.6%）心力衰竭（HF）事件和106例（1.5%）缺血性卒中（IS）事件。动脉粥样硬化血栓形成风险的患病率随着蛋白尿水平的升高而增加。从蛋白尿阴性组到微量组再到阳性组，全因死亡、HF和IS事件的发生率显著增加（对数秩检验，趋势P < 0.001）。多变量分析显示蛋白尿与全因死亡[风险比（HR）：1.50，95%置信区间（CI）1.07 - 2.1]、HF（HR：1.55，95% CI 1.14 - 2.12）和IS（HR：2.08，95% CI 1.26 - 3.45）之间存在独立关联。即使是微量蛋白尿也与HF（HR：1.64，95% CI 1.07 - 2.53）、IS（HR：2.17，95% CI 1.14 - 4.11）以及全因死亡（HR：1.56，95% CI 0.99 - 2.47）独立相关。总之，试纸条蛋白尿与心血管事件和死亡独立相关，这表明UDT是评估患者发生此类不良事件风险的有用工具。
