Table_4_High Normal Urinary Albumin–Creatinine Ratio Is Associated With Hypertension, Type 2 Diabetes Mellitus, HTN With T2DM, Dyslipidemia, and Cardiovascular Diseases in the Chinese Population: A Report From the REACTION Study.docx

BackgroundAlbuminuria has been widely considered a risk factor for cardiovascular diseases (CVDs), which is associated with hypertension (HTN), type 2 diabetes mellitus (T2DM), HTN with T2DM, and dyslipidemia. However, the associations between albuminuria and HTN, T2DM, HTN with T2DM, dyslipidemia, and CVDs are still unclear. Thus, this study aimed to explore the association of albuminuria thoroughly, especially within the normal range, with the abovementioned diseases in the Chinese population.
MethodsThis study included 40,188 participants aged over 40 years from seven centers across China. Urinary albumin–creatinine ratio (UACR) was firstly divided into the ≥30-mg/g group, indicating kidney damage, and <30-mg/g group. Furthermore, UACR was divided into five groups: the <20%, 20%–39%, 40%–59%, 60%–79%, and ≥80% groups, according to the quintile division of participants within the normal range. Propensity score matching was used to reduce bias, and multiple logistic regression models were conducted to examine the association between UACR and HTN, T2DM, HTN with T2DM, dyslipidemia, and CVDs.
ResultsMultivariable regression analysis revealed that UACR, even within the normal range, is significantly associated with HTN, T2DM, HTN with T2DM, dyslipidemia, and CVDs, and the association between UACR and HTN with T2DM was the most significant in model 3 even after adjusting for confounding factors (HTN: OR = 1.56 (95% CI = 1.45–1.68), p < 0.0001; T2DM: OR = 1.78 (95% CI = 1.60–1.97), p < 0.0001; HTN with T2DM: OR = 1.76 (95% CI = 1.59–1.95), p < 0.0001; dyslipidemia: OR = 1.08 (95% CI = 1.01–1.14), p = 0.0146; CVDs: OR = 1.12 (95% CI = 1.00–1.25), p = 0.0475). In the stratified analysis, high normal UACR was significantly associated with HTN, T2DM, HTN with T2DM, and dyslipidemia in subgroups.
ConclusionsIn summary, we observe a higher prevalence of HTN, T2DM, HTN with T2DM, dyslipidemia, and CVDs in abnormal UACR and reveal a significant association of UACR, even within the normal range, with HTN, T2DM, HTN with T2DM, dyslipidemia, and CVDs.

研究背景：白蛋白尿（albuminuria）已被广泛认为是心血管疾病（cardiovascular diseases, CVDs）的危险因素，且与高血压（hypertension, HTN）、2型糖尿病（type 2 diabetes mellitus, T2DM）、高血压合并2型糖尿病以及血脂异常密切相关。然而，白蛋白尿与上述高血压、2型糖尿病、高血压合并2型糖尿病、血脂异常及心血管疾病之间的关联仍不明确。因此，本研究旨在全面探讨中国人群中白蛋白尿（尤其处于正常参考范围内时）与上述疾病的关联。
研究方法：本研究纳入了来自中国7个中心的40188名40岁以上参与者。首先将尿白蛋白肌酐比（urinary albumin–creatinine ratio, UACR）分为≥30mg/g组（提示肾损伤）与<30mg/g组；进一步依据正常范围内参与者的五分位分组原则，将UACR划分为<20%五分位组、20%~39%五分位组、40%~59%五分位组、60%~79%五分位组及≥80%五分位组。本研究采用倾向得分匹配以减少偏倚，并构建多因素logistic回归模型，分析UACR与高血压、2型糖尿病、高血压合并2型糖尿病、血脂异常及心血管疾病之间的关联。
研究结果：多因素回归分析显示，即使处于正常参考范围内，UACR仍与高血压、2型糖尿病、高血压合并2型糖尿病、血脂异常及心血管疾病存在显著关联；在校正混杂因素后的模型3中，UACR与高血压合并2型糖尿病的关联最为显著（高血压：比值比（odds ratio, OR）=1.56，95%置信区间（confidence interval, CI）=1.45~1.68，p<0.0001；2型糖尿病：OR=1.78，95%CI=1.60~1.97，p<0.0001；高血压合并2型糖尿病：OR=1.76，95%CI=1.59~1.95，p<0.0001；血脂异常：OR=1.08，95%CI=1.01~1.14，p=0.0146；心血管疾病：OR=1.12，95%CI=1.00~1.25，p=0.0475）。分层分析结果表明，正常高值UACR在各亚组中均与高血压、2型糖尿病、高血压合并2型糖尿病及血脂异常存在显著关联。
研究结论：综上，本研究发现尿白蛋白肌酐比异常的人群中高血压、2型糖尿病、高血压合并2型糖尿病、血脂异常及心血管疾病的患病率更高；同时证实即使UACR处于正常参考范围内，其与上述疾病仍存在显著关联。