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Article(id=1240375113594499237, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311041, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1698854400000, receivedDateStr=2023-11-02, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658072136, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658072136, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658072136, creator=13701087609, updateTime=1773658072136, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1094, endPage=1098, ext={EN=ArticleExt(id=1240375115133808825, articleId=1240375113594499237, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A study on the correlation between microalbuminuria and 24 h urine sodium, urine potassium and the ratio of sodium to potassium among people in elderly care facilities, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between 24-hour urinary sodium, urinary potassium, sodium-potassium ratio and microalbuminuria among people in elderly care institutions.

Methods

Questionnaire survey, physical examination, blood and 24 h urine samples collection were carried out in the elderly people of 16 elderly care institutions in southeastern Shanxi from September 2017 to November 2017, which were selected using the random cluster sampling method. A multivariate logistic regression model was used to analyze the association between 24 h urinary sodium excretion, urinary potassium excretion, sodium-potassium ratio and MAU.

Results

A total of 502 subjects including 467 males (93.03%) and 33 MAU (6.57%) were included in this study (average age: 65.77±8.54 years old). The 24 h urinary sodium excretion was (193.02±87.64) mmol, urinary potassium excretion was (27.95±15.02) mmol, and the sodium-potassium ratio was (7.44±2.62), respectively. Multivariate logistic regression analysis showed that group with the highest urinary sodium excretion and the sodium-potassium ratio (Q4) compared to the lowest group (Q1) was associated with an increased risk of MAU (OR=4.026, 95% CI: 1.045-15.515; OR=4.043, 95% CI: 1.252-13.057).

Conclusion

The 24-hour urinary sodium and sodium-potassium ratio are positively associated with the prevalence of MAU, while 24-hour urinary potassium is not related to the prevalence of MAU.

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目的

了解集体养老人群24 h尿钠、尿钾、钠钾比与微量白蛋白尿（microalbuminuria，MAU）的关系。

方法

采用随机整群抽样方法于2017年9月至2017年11月在山西省东南部地区16家养老机构进行问卷调查、体格检查、血液及24 h尿液标本收集。采用多因素非条件logistic回归分析24 h尿钠、尿钾、钠钾比与微量白蛋白尿的相关性。

结果

本次纳入研究对象502人，平均年龄为65.77±8.54岁，男性467人（93.03%），24小时尿钠、尿钾、钠钾比分别为(193.02±87.64) mmol、(27.95±15.02) mmol、（7.44±2.62），MAU者33人（6.57%）；多因素logistic回归分析显示：较高的24 h尿钠与钠钾比水平（Q4）与最低水平（Q1）相比，MAU的发生风险增加（OR=4.026，95% CI：1.045~15.515；OR=4.043，95% CI：1.252~13.057）。

结论

MAU的发生与24 h尿钠、钠钾比呈正相关，而与24 h尿钾无关。

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冯向先，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=NyiXsU2vCE4N7fjWEkMOJw==, magXml=J/OMUcweqsBG0B44Br4sIQ==, pdfUrl=null, pdf=1ZxIh3ThZSIFS3F5hRM4mA==, pdfFileSize=448411, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=6Of2nS3j589dAtChkGxtWA==, mapNumber=null, authorCompany=null, fund=null, authors=

段培芬（1980—），女，硕士，副教授，研究方向：慢性病流行病学

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段培芬（1980—），女，硕士，副教授，研究方向：慢性病流行病学

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段培芬（1980—），女，硕士，副教授，研究方向：慢性病流行病学

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Mayo Clinic, 2022, 97(12): 2259-2270., articleTitle=Urinary Sodium-to-Potassium ratio and incident chronic kidney disease: results from the Korean genome and epidemiology study, refAbstract=null), Reference(id=1240746305841058777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, doi=null, pmid=null, pmcid=null, year=2016, volume=24, issue=5, pageStart=435, pageEnd=439, url=null, language=null, rfNumber=[14], rfOrder=20, authorNames=孟婷婷, 徐新娟, 陈玉岚, journalName=中华高血压杂志, refType=null, unstructuredReference=孟婷婷，徐新娟，陈玉岚，等．原发性高血压患者尿微量白蛋白/肌酐与尿钠、尿钾的相关性[J]．中华高血压杂志，2016，24（5）：435-439．, articleTitle=原发性高血压患者尿微量白蛋白/肌酐与尿钠、尿钾的相关性, refAbstract=null), Reference(id=1240746305975276514, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, doi=null, pmid=null, pmcid=null, year=2016, volume=24, issue=5, pageStart=435, pageEnd=439, url=null, language=null, rfNumber=[14], rfOrder=21, authorNames=Meng TT, Xu XJ, Chen YL, journalName=Chinese Journal of Hypertension, refType=null, unstructuredReference=Meng TT, Xu XJ, Chen YL, et al. 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Asia Pacific Journal of Clinical Nutrition, 2016, 25(4): 785-797., articleTitle=Population-based association between urinary excretion of Sodium, Potassium and its ratio with albuminuria in Chinese, refAbstract=null)], funds=[Fund(id=1240746303244784446, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, awardId=2016YFC1300200-3, language=CN, fundingSource=国家重点研发计划项目(2016YFC1300200-3), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746299998392985, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, xref=1., ext=[AuthorCompanyExt(id=1240746300006781595, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, companyId=1240746299998392985, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi 046000, China), AuthorCompanyExt(id=1240746300015170205, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, companyId=1240746299998392985, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.长治医学院公共卫生与预防医学系，山西 长治 046000)]), AuthorCompany(id=1240746300115833508, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, xref=2., ext=[AuthorCompanyExt(id=1240746300124222115, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, companyId=1240746300115833508, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.长治医学院第二临床学院)])], figs=[ArticleFig(id=1240746302305260318, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=EN, label=Table 1, caption=

Description of general characteristics of the subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量MAU组（n=33）非MAU组（n=469）t/χ2/Z值P值
年龄（，岁）68.61±7.3565.57±8.591.9780.048
男性 [n(%)]29（87.88）438（93.39）0.7190.396
吸烟 [n(%)]14（42.42）222（47.33）0.2980.585
饮酒 [n(%)]5（15.15）69（14.71）0.0050.945
经常锻炼身体 [n(%)]20（60.61）335（71.43）1.7440.187
糖尿病 [n(%)]5（15.15）18（3.84）6.6240.010
脑卒中 [n(%)]13（39.39）122（26.01）2.8080.094
冠心病 [n(%)]7（21.21）51（10.87）2.2920.130
肾脏疾病 [n(%)]3（9.09）17（3.62）1.1910.275
肿瘤 [n(%)]2（6.06）6（1.28）-0.091
COPD [n(%)]2（6.06）7（1.49）-0.113
高血压 [n(%)]27（81.82）303（64.61）4.0550.044
BMI[M（P25，P75），kg/m2]24.18（23.42,25.98）24.18（22.07,26.02）-1.0830.279
收缩压[M（P25，P75），mmHg]138.67（130.33,138.67）136.33（122.00,149.17）-1.5950.111
舒张压[M（P25，P75），mmHg]82.67（79.33,90.67）82.33（74.33,90.17）-1.0090.313
尿钠[M（P25，P75），mmol]203.18（159.07,273.86）184.84（131.41,237.24）-1.5540.120
尿钾M（P25，P75），mmol]26.21（17.02,33.84）25.20（18.45,34.95）-0.3230.746
钠钾比[M（P25，P75）]7.43（6.13,9.98）7.13（5.60,8.91）-1.5040.133
总胆固醇[M（P25，P75），mmol/L]4.73（3.88,5.45）4.29（3.84,4.98）-1.3800.168
甘油三酯[M（P25，P75），mmol/L]1.49（1.12,2.04）1.24（0.91,1.70）-2.5190.012
高密度脂蛋白[M（P25，P75），mmol/L]1.04（0.90,1.18）1.08（0.95,1.23）-1.0900.276
低密度脂蛋白[M（P25，P75），mmol/L]2.84（2.29,3.30）2.56（2.18,3.07）-1.7870.074
空腹血糖[M（P25，P75），mmol/L]5.41（4.94,5.84）5.02（4.73,5.43）-2.2210.026
), ArticleFig(id=1240746302502392612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=CN, label=表1, caption=

研究对象一般情况描述

, figureFileSmall=null, figureFileBig=null, tableContent=
变量MAU组（n=33）非MAU组（n=469）t/χ2/Z值P值
年龄（，岁）68.61±7.3565.57±8.591.9780.048
男性 [n(%)]29（87.88）438（93.39）0.7190.396
吸烟 [n(%)]14（42.42）222（47.33）0.2980.585
饮酒 [n(%)]5（15.15）69（14.71）0.0050.945
经常锻炼身体 [n(%)]20（60.61）335（71.43）1.7440.187
糖尿病 [n(%)]5（15.15）18（3.84）6.6240.010
脑卒中 [n(%)]13（39.39）122（26.01）2.8080.094
冠心病 [n(%)]7（21.21）51（10.87）2.2920.130
肾脏疾病 [n(%)]3（9.09）17（3.62）1.1910.275
肿瘤 [n(%)]2（6.06）6（1.28）-0.091
COPD [n(%)]2（6.06）7（1.49）-0.113
高血压 [n(%)]27（81.82）303（64.61）4.0550.044
BMI[M（P25，P75），kg/m2]24.18（23.42,25.98）24.18（22.07,26.02）-1.0830.279
收缩压[M（P25，P75），mmHg]138.67（130.33,138.67）136.33（122.00,149.17）-1.5950.111
舒张压[M（P25，P75），mmHg]82.67（79.33,90.67）82.33（74.33,90.17）-1.0090.313
尿钠[M（P25，P75），mmol]203.18（159.07,273.86）184.84（131.41,237.24）-1.5540.120
尿钾M（P25，P75），mmol]26.21（17.02,33.84）25.20（18.45,34.95）-0.3230.746
钠钾比[M（P25，P75）]7.43（6.13,9.98）7.13（5.60,8.91）-1.5040.133
总胆固醇[M（P25，P75），mmol/L]4.73（3.88,5.45）4.29（3.84,4.98）-1.3800.168
甘油三酯[M（P25，P75），mmol/L]1.49（1.12,2.04）1.24（0.91,1.70）-2.5190.012
高密度脂蛋白[M（P25，P75），mmol/L]1.04（0.90,1.18）1.08（0.95,1.23）-1.0900.276
低密度脂蛋白[M（P25，P75），mmol/L]2.84（2.29,3.30）2.56（2.18,3.07）-1.7870.074
空腹血糖[M（P25，P75），mmol/L]5.41（4.94,5.84）5.02（4.73,5.43）-2.2210.026
), ArticleFig(id=1240746302590472996, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=EN, label=Table 2, caption=

Logistic regression analysis of 24h urinary sodium and MAU

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤134.08）1.000
Q2(134.09~186.35)0.6610.6001.2120.2711.936（0.597~6.276）
Q3(186.36~239.79)0.8360.5912.0040.1572.308（0.725~7.350）
Q4(>239.79)1.1310.5803.7980.0513.098（0.994~9.660）
模型2
Q1（≤134.08）1.000
Q2(134.09~186.35)0.6870.6221.2200.2691.988（0.587~6.727）
Q3(186.36~239.79)1.0520.6422.6860.1012.865（0.814~10.085）
Q4(>239.79)1.3930.6881.0960.0434.026（1.045~15.515）
), ArticleFig(id=1240746302691136295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=CN, label=表2, caption=

24小时尿钠与MAU关联的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤134.08）1.000
Q2(134.09~186.35)0.6610.6001.2120.2711.936（0.597~6.276）
Q3(186.36~239.79)0.8360.5912.0040.1572.308（0.725~7.350）
Q4(>239.79)1.1310.5803.7980.0513.098（0.994~9.660）
模型2
Q1（≤134.08）1.000
Q2(134.09~186.35)0.6870.6221.2200.2691.988（0.587~6.727）
Q3(186.36~239.79)1.0520.6422.6860.1012.865（0.814~10.085）
Q4(>239.79)1.3930.6881.0960.0434.026（1.045~15.515）
), ArticleFig(id=1240746302787605291, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=EN, label=Table 3, caption=

Logistic regression analysis of 24h urinary potassium and MAU

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤18.30）1.000
Q2(18.31~25.24)-0.2460.5050.2370.6260.782（0.290~2.105）
Q3(25.25~34.65)-0.2010.4970.1640.6860.818（0.308~2.168）
Q4(>34.65)-0.2780.5190.2860.5930.757（0.274~2.095）
模型2
Q1（≤18.30）1.000
Q2(18.31~25.24)-0.2480.5140.2330.6290.780（0.285~2.136）
Q3(25.25~34.65)-0.2920.5070.3330.5640.746（0.277~2.015）
Q4(>34.65)-0.3170.5260.3630.5470.728（0.260~2.041）
), ArticleFig(id=1240746302892462894, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=CN, label=表3, caption=

24小时尿钾与MAU关联的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤18.30）1.000
Q2(18.31~25.24)-0.2460.5050.2370.6260.782（0.290~2.105）
Q3(25.25~34.65)-0.2010.4970.1640.6860.818（0.308~2.168）
Q4(>34.65)-0.2780.5190.2860.5930.757（0.274~2.095）
模型2
Q1（≤18.30）1.000
Q2(18.31~25.24)-0.2480.5140.2330.6290.780（0.285~2.136）
Q3(25.25~34.65)-0.2920.5070.3330.5640.746（0.277~2.015）
Q4(>34.65)-0.3170.5260.3630.5470.728（0.260~2.041）
), ArticleFig(id=1240746302972154672, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=EN, label=Table 4, caption=

Logistic regression analysis of 24h urinary sodium-potassium ratio and MAU

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤5.73）1.000
Q2(5.74~7.13)0.4640.6630.4910.4831.591（0.434~5.834）
Q3(7.14~8.94)0.8350.6181.8210.1772.304（0.686~7.743）
Q4(>8.94)1.4340.5895.9240.0154.194（1.322~13.305）
模型2
Q1（≤5.73）1.000
Q2(5.74~7.13)0.4300.6700.4130.5201.538（0.414~5.717）
Q3(7.15~8.94)0.7670.6271.4960.2212.153（0.630~7.353）
Q4(>8.94)1.3970.5985.4550.0204.043（1.252~13.057）
), ArticleFig(id=1240746303060235062, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375113594499237, language=CN, label=表4, caption=

24 h尿钠钾比与MAU关联的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量βSβWald χ2值P值OR（95% CI）
模型1
Q1（≤5.73）1.000
Q2(5.74~7.13)0.4640.6630.4910.4831.591（0.434~5.834）
Q3(7.14~8.94)0.8350.6181.8210.1772.304（0.686~7.743）
Q4(>8.94)1.4340.5895.9240.0154.194（1.322~13.305）
模型2
Q1（≤5.73）1.000
Q2(5.74~7.13)0.4300.6700.4130.5201.538（0.414~5.717）
Q3(7.15~8.94)0.7670.6271.4960.2212.153（0.630~7.353）
Q4(>8.94)1.3970.5985.4550.0204.043（1.252~13.057）
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集体养老人群中微量白蛋白尿与24 h尿钠、尿钾及钠钾比相关性研究
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段培芬 1 , 郝嘉琪 2 , 原建慧 1 , 冯向先 1
现代预防医学 | 疾病预防控制 2024,51(6): 1094-1098
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现代预防医学 | 疾病预防控制 2024, 51(6): 1094-1098
集体养老人群中微量白蛋白尿与24 h尿钠、尿钾及钠钾比相关性研究
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段培芬1, 郝嘉琪2, 原建慧1, 冯向先1
作者信息
  • 1.长治医学院公共卫生与预防医学系，山西 长治 046000
  • 2.长治医学院第二临床学院

    • 段培芬（1980—），女，硕士，副教授，研究方向：慢性病流行病学

通讯作者:

冯向先，E-mail：
A study on the correlation between microalbuminuria and 24 h urine sodium, urine potassium and the ratio of sodium to potassium among people in elderly care facilities
Pei-fen DUAN1, Jia-qi HAO2, Jian-hui YUAN1, Xiang-xian FENG1
Affiliations
  • Department of Preventive Medicine, Changzhi Medical College, Changzhi, Shanxi 046000, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202311041
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摘要
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目的

了解集体养老人群24 h尿钠、尿钾、钠钾比与微量白蛋白尿（microalbuminuria，MAU）的关系。

方法

采用随机整群抽样方法于2017年9月至2017年11月在山西省东南部地区16家养老机构进行问卷调查、体格检查、血液及24 h尿液标本收集。采用多因素非条件logistic回归分析24 h尿钠、尿钾、钠钾比与微量白蛋白尿的相关性。

结果

本次纳入研究对象502人，平均年龄为65.77±8.54岁，男性467人（93.03%），24小时尿钠、尿钾、钠钾比分别为(193.02±87.64) mmol、(27.95±15.02) mmol、（7.44±2.62），MAU者33人（6.57%）；多因素logistic回归分析显示：较高的24 h尿钠与钠钾比水平（Q4）与最低水平（Q1）相比，MAU的发生风险增加（OR=4.026，95% CI：1.045~15.515；OR=4.043，95% CI：1.252~13.057）。

结论

MAU的发生与24 h尿钠、钠钾比呈正相关，而与24 h尿钾无关。

24 h尿钠  /  24 h尿钾  /  钠钾比  /  微量白蛋白尿
Objective

To investigate the relationship between 24-hour urinary sodium, urinary potassium, sodium-potassium ratio and microalbuminuria among people in elderly care institutions.

Methods

Questionnaire survey, physical examination, blood and 24 h urine samples collection were carried out in the elderly people of 16 elderly care institutions in southeastern Shanxi from September 2017 to November 2017, which were selected using the random cluster sampling method. A multivariate logistic regression model was used to analyze the association between 24 h urinary sodium excretion, urinary potassium excretion, sodium-potassium ratio and MAU.

Results

A total of 502 subjects including 467 males (93.03%) and 33 MAU (6.57%) were included in this study (average age: 65.77±8.54 years old). The 24 h urinary sodium excretion was (193.02±87.64) mmol, urinary potassium excretion was (27.95±15.02) mmol, and the sodium-potassium ratio was (7.44±2.62), respectively. Multivariate logistic regression analysis showed that group with the highest urinary sodium excretion and the sodium-potassium ratio (Q4) compared to the lowest group (Q1) was associated with an increased risk of MAU (OR=4.026, 95% CI: 1.045-15.515; OR=4.043, 95% CI: 1.252-13.057).

Conclusion

The 24-hour urinary sodium and sodium-potassium ratio are positively associated with the prevalence of MAU, while 24-hour urinary potassium is not related to the prevalence of MAU.

24-hour urine sodium  /  24-hour urine potassium  /  Sodium-potassium ratio  /  Microalbuminuria
段培芬, 郝嘉琪, 原建慧, 冯向先. 集体养老人群中微量白蛋白尿与24 h尿钠、尿钾及钠钾比相关性研究. 现代预防医学, 2024 , 51 (6) : 1094 -1098 . DOI: 10.20043/j.cnki.MPM.202311041
Pei-fen DUAN, Jia-qi HAO, Jian-hui YUAN, Xiang-xian FENG. A study on the correlation between microalbuminuria and 24 h urine sodium, urine potassium and the ratio of sodium to potassium among people in elderly care facilities[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1094 -1098 . DOI: 10.20043/j.cnki.MPM.202311041
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微量白蛋白尿（microalbuminuria，MAU）即尿中出现微量的白蛋白，是指由各种原因引起的肾小球滤过功能下降导致白蛋白滤出增多，而肾小管重吸收功能受损或代偿不足导致的蛋白尿增多的现象，是心血管疾病肾功能改变的早期指征[1-2]，其诊断标准为尿微量白蛋白/肌酐为30~300 mg/g，或定量分析中8 h尿微量白蛋白为20~200 μg/min，或24 h尿微量白蛋白排出量为30~300 mg之间[3]。其中基于24 h尿液的尿微量白蛋白排泄测定法是诊断MAU的金标准[4]。已有研究表明高钠低钾饮食会增加慢性肾损伤的发生风险，意味着可能导致MAU[5]。目前，人群中的钠钾摄入情况评估主要通过24 h尿液中钠、钾排泄量来进行估算[6]。关于24小时尿钠、尿钾及钠钾比与MAU关系的研究较少且主要以临床患者为研究对象，结果不一[7-10]，在一般人群中研究较少。本研究以养老机构为研究现场，探讨集体养老机构人群中24 h尿钠、尿钾及钠钾比与微量白蛋白尿的关系。
1 对象与方法
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1.1 研究对象
采用随机整群抽样的方法于2017年9月—11月选取山西省东南部地区16家养老机构45~95岁人群作为研究对象。研究经北京大学生物医学伦理委员会审查批准（审批号：IRB00001052-17079），所有研究对象均签署知情同意书。
1.2 研究内容与方法
1.2.1 问卷调查
统一培训调查员后对研究对象进行面对面问卷调查。调查内容主要包括一般人口学特征、身体健康状况、生活行为方式、疾病史、用药史及药品名称、剂量等。
1.2.2 体格检查
采用校准的身高计和体重仪测量身高和体重；使用欧姆龙电子血压计（HEM-7136）进行血压测量，受试者取坐位，统一右上臂，连续测量3次取平均值，时间间隔为30秒。
1.2.3 血尿液标本收集及检测[11]
调查当天采集空腹（12小时）血液样本，静置30分钟后现场离心提取血清标本；并为调查对象发放尿桶、讲解24小时尿样收集过程及注意事项，次日将所留24小时尿液称重后并混匀提取尿液标本。血尿液标本冷链转运至北京中心实验室进行检测。采用离子电极法测定血清及尿电解质相关指标；采用酶法测定肌酐；采用免疫比浊法测定尿微量白蛋白。
1.3 相关定义
（1）高血压：收缩压≥140 mmHg或舒张压≥90 mmHg，或在2周内服用抗高血压药物；（2）糖尿病：空腹血糖≥126 mg/dl(7.0 mmol/L)或自行报告糖尿病史；（3）BMI=体重（kg）/身高2（m2）；（4）尿样合格：24小时尿量>500 ml且留尿时间为22~26 h；（5）MAU：24小时尿微量白蛋白为30~300 mg。
1.4 统计学方法
采用SPSS 22.0软件进行统计分析。计量资料在正态分布下用进行统计描述，组间比较采用t检验；偏态分布下用M（P25，P75）进行描述，组间比较采用秩和检验；计数资料用[n(%)]表示，采用χ2检验或Fisher确切概率法进行组间比较，等级资料采用Z检验。将研究对象的24小时尿钠、尿钾以及钠钾比按其四分位数分成Q1~Q4组，以是否MAU（0=否，1=是）为因变量，建立多因素非条件logistic回归模型，均以24小时尿钠、尿钾以及钠钾比Q1组作为参照，调整相关因素后分别分析尿钠、尿钾以及钠钾比与MAU的关系，检验水准α=0.05。
2 结果
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2.1 一般情况
本次研究纳入研究对象502人，平均年龄为65.77±8.54岁，其中男性467人（93.03%），文化程度以小学及以下为主（78.49%），24小时尿钠、尿钾、钠钾比分别为(193.02±87.64) mmol、(27.95±15.02) mmol、（7.44±2.62），MAU者33人（6.57%），MAU组与非MAU组一般情况见表1。
2.2 24小时尿钠与MAU的关系
从Q1~Q4，MAU检出率依次为4.0%（5/125）、6.35%（8/126）、7.14%（9/126）、8.8%（11/125），差异无统计学意义（Z=-1.531，P=0.126）；以MAU为因变量，24小时尿钠四分位数为自变量，建立logistic回归模型，对性别与年龄进行调整后，模型1显示：尿钠与MAU的发生风险无关（P=0.051），在模型1基础上进一步调整吸烟、饮酒、锻炼身体、尿钾等因素后。模型2显示：与Q1组相比，Q4组发生MAU的风险增加（OR=4.026，95% CI：1.045~15.515）。见表2。
2.3 24小时尿钾与MAU的关系
24小时尿钾Q1~Q4组MAU检出率依次为8.0%（10/125）、6.30%（8/127）、6.4%（8/125）、5.6%（7/125），差异无统计学意义（Z=-0.715，P=0.475）；模型1、2均显示：尿钾与MAU的发生无关联（P=0.593；P=0.547）（表3）。
2.4 钠钾比与MAU的关系
Q1~Q4组MAU检出率分别为3.20%（4/125）、4.72%（6/127）、7.14%（9/126）、11.29%（14/124），差异有统计学意义（Z=-2.684，P=0.007）；对性别与年龄进行调整后，模型1显示：与Q1组相比，Q4组发生MAU的风险增加（OR=4.194，95% CI：1.322~13.305），模型2显示：与Q1组相比，Q4组发生MAU的风险增加（OR=4.043，95% CI：1.252~13.057）。见表4。
3 讨论
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本次研究通过24 h尿液这一金标准来检测尿钾、尿钠、钠钾比及微量白蛋白，结果显示机构养老人群中微量白蛋白尿检出率为6.57%，略低于徐建伟[1]在中国六省的检出结果。对相关因素进行调整后发现较高24 h尿钠、钠钾比水平增加MAU发生风险；尿钾水平与MAU发生无关。
关于尿钠、尿钾及钠钾比与MAU的关联性国内外研究较少且结果不完全一致。本研究显示与24 h尿钠Q1组人群相比较，Q4组人群MAU的发生风险增加（OR=4.026，95% CI：1.045~15.515），可能与钠对血管壁的不良影响有关。国内两项[6-7]针对普通人群中24 h尿钠与MAU关联性研究的结果均显示较高的24 h尿钠水平可增加MAU的发生风险（OR=2.74，95% CI：1.80~4.16；OR=1.586，95% CI：1.359~3.597）；一项整群随机对照试验中发现减少膳食钠的摄入可显著降低MAU的发生[8]；一项针对韩国人群的研究结果显示24 h尿钠Q4组与Q1组相比，MAU的发生风险增加。而刘欢等则[9-10]认为尿钠与MAU无关。
本次研究表明调整相关因素后24 h尿钾与MAU发生无关。Sun等[12-13]亦认为24 h尿钾与MAU无关，与本研究结果一致；但孟婷婷[14]在高血压患者人群研究中发现较高尿钾水平与MAU发生存在弱关联（OR=0.987，95% CI：0.978~0.996），国外亦有研究结果显示24 h尿钾与微量白蛋白尿发生有关[15-16]。有动物实验表明[17]，低钾与肾损害有关，增加钾的摄入可通过改善肾功能进而降低血管阻力，增加eGFR，发挥其保护作用。造成研究结果的不一致可能与本地区钾摄入较低有关，亦可能与研究对象选择、尿样收集及检测方法不同有关。
有研究显示，尿钠钾比更能预测肾功能[18]。本次研究显示24 h尿钠钾比Q4组人群MAU的发生风险较Q1组人群高（OR=4.043，95% CI：1.252~13.057）。一项前瞻性队列研究显示[19]钠钾比是肾功能下降的预测因子；另一项队列研究亦发现[5]高Na/K比增加CKD发病风险；但来自山东和浙江的一般人群研究结果显示钠钾比与MAU无关[20-21]。
尽管本研究采用了标准化的设计，但依然存在一定的局限性。首先，受养老机构特殊性质影响，本次研究对象主要以男性为主，不能全面反映一般人群24 h尿钠、尿钾及钠钾比与MAU的关联；其次，虽然本次研究采用了24 h尿液这一金标准进行指标检测，但由于只收集了单个24 h尿液标本，致使研究结果可能出现偏性；再次，虽然考虑到混杂因素对研究结果的影响，但本次研究只对部分可能混杂因素进行了调整，其结果依然可能存在混杂偏倚；最后，本研究是横断面调查结果且样本量不是很大，无法判断其因果关系，因此需要在大样本、前瞻性研究设计中进一步加以验证。
综上所述，本次研究结果表明24 h尿钠、钠钾比会增加MAU的发生风险，而24 h尿钾则与MAU的发生无关，应倡导高钾低钠饮食，预防早期肾功能损伤。
基金
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  • 国家重点研发计划项目(2016YFC1300200-3)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202311041
  • 接收时间：2023-11-02
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-11-02
基金
国家重点研发计划项目(2016YFC1300200-3)
作者信息
    1.长治医学院公共卫生与预防医学系，山西 长治 046000
    2.长治医学院第二临床学院

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