尿液試紙檢測白蛋白/肌酸酐比值(ACR)作為健康風險指標的探討-與代謝症候群、心血管疾病風險和腎功能異常的相關性

Investigation of albumin-to-creatinine ratio(ACR) detected by the urine test strip as a health risk index -Correlation with metabolic syndrome、cardiovascular disease risk and renal dysfunction

吳宛玲(Wan-Ling Wu)

指導教授 ： 彭瓊瑜

共同指導教授 ： 戴嘉言(Chia-Yen Dai)

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2021年)

摘要

研究背景：心血管疾病和腎炎、腎病症候群及腎病為國人十大死因排名第二名和第九名。代謝症候群、心血管疾病、慢性腎臟疾病共同的獨立風險因子是微量白蛋白尿，臨床上微量白蛋白是以定量方法檢測，成本高不符合一般健康檢查的篩檢效益，本研究想了解是否能用尿液試紙中的白蛋白/肌酸酐比值(U-ACR)作為健康風險的指標和篩檢工具。
研究方法：本研究資料取自南部某醫學中心-健康管理中心資料庫，收錄時間自108年1月至6月共5817名。以全自動尿液分析儀器UC-3500(Sysmex)和半定量尿液試紙(MEDITAPE UC-11A sticks)作為檢測工具，分析尿液白蛋白/肌酐酸比值(urinary albumin/creatinine ratio，UACR)與代謝症候群、腎功能異常(eGFR<60)和心血管疾病風險的相關性。統計分析採SPSS 22.0進行分析，p<0.05視為統計上的顯著差異。
研究結果：經過不同變項校正後，UACR陽性組發生腎功能異常(eGFR<60)的機率是UACR陰性組的2.30倍，達顯著相關(95% CI：1.64-3.23，p<0.001)；UACR陽性組發生代謝症候群的機率是UACR陰性組的2.16倍，達顯著相關(95% CI：1.77-2.63，p<0.001)；UACR陽性組發生FRS中度風險的機率是UACR陰性組的1.56倍，達顯著相關(95% CI：1.31-1.85，p<0.001)；UACR陽性組發生FRS高度風險的機率是UACR陰性組的2.68倍，達顯著相關(95% CI：1.98-3.63，p<0.001)；相較於FRS中度風險，其UACR陽性組發生FRS高度風險的機率是UACR陰性組的1.72倍，達顯著相關(95% CI：1.28-2.31，p<0.001)。腎功能異常(eGFR<60)的敏感度、特異性和準確率分別為38.2%、84.2%和82.5%。代謝症候群的敏感度、特異性和準確率分別為28.9%、87.0%和73.8%。FRS中度風險敏感度、特異性和準確率分別為20.1%、88.0%和 59.5%。FRS高度風險的敏感度、特異性和準確率分別為37.2%、88.0%和83.4%。
結論：UACR陽性是代謝症候群、心血管疾病風險和腎功能異常(eGFR<60)的獨立風險因子，可以做為健康風險的早期指標。雖然該試紙在偵測代謝症候群、心血管疾病風險和腎功能異常的敏感度、陽性預測值很低，但特異性和陰性預測值很高，可用於一般健康族群的檢查。

關鍵字

尿液肌酐酸/白蛋白比值 ； 代謝症候群 ； 心血管疾病風險 ； 腎功能異常

並列摘要

Background
Cardiovascular diseases and renal-related disease ranked second and ninth for the top ten causes of death for the Taiwanese. Of these disease and metabolic syndrome, microalbuminuria is their common risk factor. Clinically, urine albumin was quantified by the advanced instrument. It was not a cost-effective method in terms of screening purpose for the general population. Therefore, the objective of this study was to assess the urine Albumin-to-creatinine ratio (U-ACR) detected by the test strip as a health risk index.
Methods
Urine samples were collected from the health management center of a medical center in southern Taiwan from January – June, 2019, with the total sample size of 5817. These samples were analyzed by an automation urine analysis instrument (Sysmex UC-3500) and a semi-quantified urine test strip. U-ACR obtained by these two analysis methods was compared. Furtherly, the correlation between U-ACR and metabolic syndrome, abnormal renal function and cardiovascular diseases were tested by statistical analysis with p<0.05 as significant level.
Results
The odds ratios of U-ACR(+) for abnormal renal function(eGFR<60), metabolic syndrome, FRS medium risk and FRS high risk were 2.30 (95% CI：1.64-3.23，p<0.001), 2.16 (95% CI：1.77-2.63，p<0.001),1.56 (95% CI：1.31-1.85，p<0.001) and 2.68 (95% CI：1.28-2.31，p<0.001) , respectively. Compared with FRS medium risk, the odds ratios of U-ACR(+) for FRS high risk was 1.72 (95% CI：1.28-2.31，p<0.001).The sensitivity, specificity and accuracy rate of abnormal renal function were 38.2%, 84.2% and 82.5%. Those of metabolic syndrome were 28.9%, 87.0% and 73.8%. Those of FRS medium risk were 20.1%, 88.0% and 59.5%. Those of FRS high risk were 37.2%, 88.0% and 83.4%.
Conclusion
According to this study’s results, U-ACR(+) detected by the urine strip can be a warning sign of metabolic syndrome, abnormal renal function, and cardiovascular disease. It can be an early biomarker for adverse health effects. Although the urine strip method had low sensitivity and positive predication value, it had high specificity and negative prediction value. This method can be applied as a screen tool for the health population.

並列關鍵字

albumin-to-creatinine ratio ； metabolic syndrome ； cardiovascular disease risk ； renal dysfunction

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