微白蛋白尿的出現,除了代表糖尿病腎病變的早期變化,也暗示著未來進展到末期腎病的危險性。然而,除了腎臟的併發症,不管是在糖尿病或是非糖尿病患者,微白蛋白尿也是心血管疾病發生及死亡率的獨立危險因子,而且不受到腎功能的影響。微白蛋白尿已成爲血管內皮細胞功能異常的指標,與血管結構及功能上的異常相關。有別於早期微白蛋白尿的定義,新近的研究發現,24小時的尿液檢查中,白蛋白尿超過30mg/day(20μg/min),或是單次小便檢查中,尿中白蛋白與肌酐酸的比值超過30mg/g時,患者發生心血管疾病的危險性就會上升。而尿液中白蛋白排出量,與心血管疾病發生危險度,呈連續相關。本文將針對微白蛋白尿的機轉及臨床應用作介紹。
Earlier study demonstrated that microalbuminuria was the earliest clinical finding of diabetic nephropathy and it also indicates higher risk in progress to end stage of renal disease. However, subsequent reports found an association between microalbuminuria and cardiovascular disease in nondiabetics and diabetics. Microalbuminuria has been recognized as a sign of endothelial dysfunction. The association between microalbuminuria and chronic disease, such as hypertension, dyslipidemia, or insulin-resistance, have also been proposed. Deferent from earlier definition of microalbuminuria, recently study has found that the risk of cardiovascular rises as the patients's microalbuminuria is equal or more than 30 mg/day (20μg/min) or urine albumin-to-creatinine ratio is equal or more than 30 mg/g. The pathophysiology and clinical application of microalbuminuria are reviewed in this article.