Olivarius N D, Mogensen C E
Central Research Unit of General Practice, Copenhagen, Denmark.
Br J Gen Pract. 1995 Feb;45(391):71-3.
Microalbuminuria may predict proteinuria and increased mortality in non-insulin dependent diabetic patients. Early detection of microalbuminuria may therefore be essential.
The primary objective of this study was to describe the association between the presence of albuminuria in diabetic patients as detected by general practitioners using conventional reagent strip dipstick tests for albumin, and the urinary albumin concentration as measured in a hospital laboratory.
A total of 675 newly diagnosed diabetic patients aged 40 years or over were included in the Danish study, diabetes care in general practice. Data for urinary albumin concentration from a morning urine sample and the results of three consecutive dipstick tests for albumin were collected for 417 patients.
When defining elevated urinary albumin concentration as 200 mg l-1 or more (proteinuria) the finding of at least one positive test out of the three dipstick tests for albumin had a diagnostic sensitivity of 73% and a specificity of 89%. When the microalbuminuric range (15.0 to 199.9 mg l-1) was added to the definition of renal involvement, the sensitivity of the dipstick test became as low as 28% with a specificity of 96%.
It is essential for general practitioners to be able to identify proteinuric patients. To achieve this by means of the conventional dipstick test, general practice procedures need to be improved. As it is becoming increasingly well-documented that microalbuminuric non-insulin dependent diabetic patients may benefit from pharmacological treatment of even slight arterial hypertension and heart failure, it seems reasonable to suggest that the use of dipsticks for albumin in general practice be replaced by laboratory quantitative determination of urinary albumin concentration in a morning urine sample.
微量白蛋白尿可能预示非胰岛素依赖型糖尿病患者出现蛋白尿及死亡率增加。因此，早期检测微量白蛋白尿可能至关重要。
本研究的主要目的是描述全科医生使用传统试剂条浸试法检测糖尿病患者尿白蛋白情况与医院实验室测量的尿白蛋白浓度之间的关联。
丹麦一项关于全科医疗中糖尿病护理的研究纳入了675名年龄40岁及以上新诊断的糖尿病患者。收集了417名患者晨尿样本的尿白蛋白浓度数据以及连续三次白蛋白浸试法检测结果。
将尿白蛋白浓度升高定义为200mg/L及以上（蛋白尿）时，三次白蛋白浸试法检测中至少有一次呈阳性的诊断敏感性为73%，特异性为89%。当将微量白蛋白尿范围（15.0至199.9mg/L）纳入肾脏受累定义时，浸试法检测的敏感性低至28%，特异性为96%。
全科医生能够识别蛋白尿患者至关重要。要通过传统浸试法实现这一点，全科医疗程序需要改进。鉴于越来越多的文献证明微量白蛋白尿的非胰岛素依赖型糖尿病患者即使对轻微动脉高血压和心力衰竭进行药物治疗也可能受益，建议在全科医疗中用晨尿样本尿白蛋白浓度的实验室定量测定取代白蛋白浸试法。
