|
微量白蛋白检测是肾衰竭的一个早期指标。它检测的是微量白蛋白，这种白蛋白在肾脏出现明显损伤之前几年就由机体排泄入尿液。白蛋白是由肝脏产生的一种蛋白质，白蛋白在血液中的浓度很高，但是如果肾脏功能良好，事实上白蛋白不会渗漏入尿液。如果一个人肾脏出现损伤或已患病，肾脏就会失去尿液中的蛋白质滤过功能。这种情况常可见于一些慢性疾病，如糖尿病和高血压等，而且随着尿液中蛋白量的增加，加快肾衰竭的进程。
尽管时段尿标本的检测没有24小时尿标本可靠，但他们可以通过肌酐来进行校准。肌酐是肌肉代谢的副产物，它以常量形式不断地被机体排泄入尿液。尿液中肌酐的浓度相对比较稳定。既然在一天中，尿液中各物质的浓度是有差异的，利用这一性质，肌酐可以作为随机尿标本的一个校准因子。在检测随机尿微量白蛋白同时进行肌酐的检测，那么微量白蛋白与肌酐比值这一结果的准确性近似于24小时尿微量白蛋白。 为何检测？ 对可能存在肾功能紊乱的患者进行筛查。 何时检测？ 美国肾脏基金会（The National Kidney Foundation）建议小于70岁的2型糖尿病患者和大于12岁的1型糖尿病患者应该每年进行微量白蛋白尿的检测。此外，初诊为2型糖尿病时，也应该进行微量白蛋白的检测。根据美国糖尿病协会的建议，对于1型糖尿病患者，可以在确诊后的5年后每年进行微量白蛋白的检测。 何种样本？ 随机尿、定时尿、夜间尿或24小时尿。 是否需要作试验前准备？ 不需要。 试验结果的含义？ 尿液中微量白蛋白中度增高表明患者有肾脏疾病的早期倾向。尿液中高浓度的微量白蛋白表示肾脏疾病已经比较严重。正常水平的微量白蛋白表明肾功能正常。 白蛋白、前白蛋白和微量白蛋白检测之间的差异? 前白蛋白检测的是一种主要反映机体营养状况的蛋白质，尤其是手术前后、住院或者需营养补充的患者要做此检测。白蛋白检测常用于肾脏疾病、肝脏疾病或者用于了解机体是否吸收足够的氨基酸。白蛋白也能够用于监测营养状况。然而，由于前白蛋白的变异较快，因此相比白蛋白，它能更好地反映短期内机体的营养状况。微量白蛋白试验检测的是尿液中浓度极低的白蛋白，并且能够反映出您是否存在肾脏疾病的危险。 测试样本如何采集？ 在医生办公室或实验室中留取随机尿、时段尿（如4小时或夜间尿）或者要求患者留取24小时尿液。医生或实验室工作人员将给您一个收集时段尿或24小时尿液标本的容器。 是否需要进行任何试验前准备以保证样本的质量？ 无需特殊检测准备。 【参考资料】 Sources Used in Current Review National Kidney Foundation. Fact Sheet: Microalbuminuria In Diabetic Kidney Disease. Available online at http://www.kidney.org/news/newsroom/fs_new/microalbindbkd.cfm through http://www.kidney.org. Accessed December 2008. MedlinePlus Medical Encyclopedia. Microalbuminuria test. Available online at http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/003591.htm. Accessed December 2008. US FDA. Diabetes Information, Glucose Meters & Diabetes Management. Available online at http://www.fda.gov/Diabetes/glucose.html#22. Accessed December 2008. American Diabetes Association. Clinical Practice Recommendations 2008. Diabetes Care. January 2008, Volume 31, Supplement 1. Available online at http://care.diabetesjournals.org/content/vol31/Supplement_1/. Accessed December 2008. Wang TJ, Gona P, Larson G, et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. New England Journal of Medicine. 21 Dec 2006. 355;25:2631-2639. High Levels Of Urinary Albumin In The Normal Range Predict Hypertension. ScienceDaily (June 25, 2008). Available online at http://www.sciencedaily.com/releases/2008/06/080625123002.htm through http://www.sciencedaily.com. Accessed December 2008. Holly Kramer et al. Urine Albumin Excretion and Subclinical Cardiovascular Disease. Hypertension. 2005;46:38. Available online at http://hyper.ahajournals.org/cgi/content/abstract/46/1/38. Accessed December 2008. Sources Used in Previous Reviews Corbett, JV. Laboratory Tests & Diagnostic Procedures with Nursing Diagnoses, 4th ed. Stamford, Conn.: Appleton & Lang, 1996. Pp. 73-74. Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Nuovo, J. (1999 June). Albumin-to-Creatinine Ratio for Detection of Microalbuminuria. American Family Physician, Tips from other Journals [On-line journal]. Available online at http://www.aafp.org/afp/990600ap/tips.html#31 through http://www.aafp.org. Fitz, M. (1999 February 2). Spot Urine Albumin to Creatinine Ratio. Loyola University Chicago Stritch School of Medicine. [On-line information, Medicine 1]. Available online at http://www.meddean.luc.edu/Lumen/meded/MEDICINE/medclerk/renal13.htm through http://www.meddean.luc.edu. Ehrmeyer, S. (2003 January). Using a creatinine ratio in urinalysis to improve the reliability of protein and albumin results. Medical Laboratory Observer, Features 35 (1) [On-line journal]. Available online at http://www.mlo-online.com/articles/mlo0103cliniss.htm through http://www.mlo-online.com. Loghman-Adham, M. (1998 October 1). Evaluating Proteinuria in Children. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/981001ap/loghman.html through http://www.aafp.org. Virtual Hospital: University of Iowa Family Practice Handbook, 3rd Edition: Hematologic, Electrolyte, and Metabolic Disorders: Bibliography. Available online at http://www.vh.org/Providers/ClinRef/FPHandbook/Chapter05/Bibliography05.html through http://www.vh.org ARUP Laboratory Guidebook. Available online at http://www.arpulab.com/guides/clt/ through http://www.arpulab.com. (Click on “microalbumin, urine”) American Diabetes Association: Community and Resources. Available online at http://www.diabetes.org. |
Copyright © 2015-2023 杭州宇翼科技有限公司 丨 Discuz! X3.5 丨增值电信业务经营许可证：浙B2-20190572丨浙ICP备18026348号-1丨浙公网安备33010802009352号
