利用時點尿估算中國人群24小時尿鈉排出量方法的探索性及適用性評價研究
發(fā)布時間：2018-07-28 17:18
【摘要】：背景：目前大量研究表明,鈉鹽攝入與高血壓密切關聯(lián),減少鈉的攝入可以有效降低血壓水平。包括美國、歐洲、中國、世界衛(wèi)生組織等一些國家地區(qū)和國際組織都在相關文件或臨床指南中提出了將限鹽策略作為控制高血壓的重要生活方式干預手段之一,并且給出了針對不同人群膳食鈉的推薦攝入量。利用時點尿估算24小時尿鈉排出(24-hour Urinary Sodium Excretion,24-h USE)是比較常用的估算人群鈉攝入水平的方法,目前最為常用的是Kawasaki公式(K法)、INTERSALT公式(I法)和Tanaka公式(T法)。但這三種公式均是以西方發(fā)達國家人群數(shù)據(jù)建立的,目前尚缺乏針對中國居民,利用時點尿估算24小時尿鈉排出量的科學方法。目的：評價時點尿估算24小時尿鈉排出量現(xiàn)有常用方法在中國居民人群中準確性。在中國正常居民中,利用不同時點尿估算24小時尿鈉排出量,探索適用于中國居民的估算方法,并評價該方法的準確性。方法：本研究根據(jù)研究目的和設計方案,通過三項獨立研究人群探索時點尿估算24小時尿鈉排出量方法。其中,在國家心血管病中心西山院區(qū)入選100名相對健康成年人群(西山人群),收集完整24小時尿樣本,各次時點尿樣本均單獨采集,并將各次時點尿混勻作為24小時尿樣本。同時利用以往的研究數(shù)據(jù),即PURE-China尿驗證人群(425名)和慢性病防治適宜技術在社區(qū)的應用項目部分尿樣本數(shù)據(jù)(德興人群152名),上述兩項研究僅采集清晨時點尿樣本和24小時尿樣本。對時點尿估算24小時尿鈉排出量進行建模探討。在考慮分析策略時,首先剔除24小時尿肌酐排出量超過正常值范圍的研究對象數(shù)據(jù),而后采取兩種建模思路,分步進行擬合。(1)由西山人群(有效分析77例)作為訓練樣本建模隨機尿新方法Ⅰ,PURE-China尿驗證人群(有效分析331例)和德興人群(有效分析133例)進行外部數(shù)據(jù)驗證。而后對西山人群數(shù)據(jù)進行不同時點尿分組比較分析(有效分析60例),并用不同時點尿數(shù)據(jù)集進行內部數(shù)據(jù)驗證；(2)以三項研究人群合并后重新隨機抽樣(有效分析541例),按照訓練樣本與驗證樣本7：3比例進行隨機抽樣(訓練樣本379例,驗證樣本162例),建模清晨晨起第二次時點尿(Second Morning Urine, SMU)新方法Ⅱ,而后進行內部數(shù)據(jù)驗證。擬合過程分步進行,即先通過年齡、性別、身高、體重進行24小時尿肌酐排出量的模型擬合,再根據(jù)時點尿鈉和尿肌酐比值與24小時尿鈉和尿肌酐比值的關聯(lián),通過線性模型進行24小時尿鈉排出量的建模擬合。通過隨機尿新方法Ⅰ和SMU新方法Ⅱ對人群估計值與實際測量值之間采用相關分析、殘差分析、Bland-Altman法進行驗證分析,并分析個體估計值與實測值之間偏差分布分析等統(tǒng)計學方法進行評價,同時將新方法與K法、I法和T法進行比較,評價新方法的準確性。根據(jù)驗證比較結果,利用新方法對PURE-China基線人群進行24小時尿鈉排出量估計,并評價鹽攝入量,以及在不同人群亞組之間鹽攝入量差異的比較。結果：根據(jù)兩種建模思路,所構建的時點尿估算24小時尿鈉排出量的新方法如下：(1)隨機尿新方法Ⅰ：男性：PrCRE24h=11.87×體重+0.417×身高-11.47×年齡+832.566女性：PrCRE24h=9.638×體重-0.085×身高-3.337×年齡+490.743e-24-h USE=2.06 X PrUCr24h X (NaRU/CrRU)0.431(2)SMU新方法Ⅱ：男性：PrCRE24h=9.39×體重-3.567×身高-4.683×年齡+1498.014女性：PrCRE24h=8.09×體重+4.417×身高-1.906×年齡-159.528e-24-h USE=2.41×PrUCr24h×(NaSMU/CrSMU)0.461注：e-24-h USE為估計的24小時尿鈉排出量,單位為mg/天；NaRU為RU尿鈉排出濃度,單位為ng/dL;CrRU為RU尿肌酐排出濃度,單位為mg/dL;PrUCr24h為估計的24小時尿肌酐排出量,單位為mg/天；體重單位為kg,身高單位為cm。新方法Ⅰ估計的24小時尿鈉排出量人群均值水平與實測值相比,低估1311 mg/天,偏差(估計值-實測值)較大；有30.6%的個體水平估計值與實測值相對偏差,即(估計值-實測值)/實測值,在±20%以內,36.4%的個體水平估計值絕對偏差(估計值-實測值)在±800 mg/天以內；新方法Ⅰ的Bland-Altman圖呈現(xiàn)橫軸相對左側的個體估計值易高估,右側的個體估計值易低估的趨勢。在利用不同時點尿樣本進行新方法Ⅰ驗證時,Bland-Altman圖顯示SMU樣本個體估計值在1.96倍標準差之間散在分布,其余各時點尿樣本估計值呈現(xiàn)可能的線性趨勢。新方法I與K法、I法和T法比較結果顯示,K法準確性較好。新方法Ⅱ估計的24小時尿鈉排出量人群均值水平與實測值相比,低估273 mg/天,偏差(估計值-實測值)較��；有30.8%的個體水平估計值與實測值相對偏差,即(估計值-實測值)/實測值,在±20%以內,32.1%的個體水平估計值絕對偏差(估計值-實測值)在±800 mg/天以內；新方法Ⅱ的Bland-Altman圖大部分個體估計值散在分布在±1.96倍標準差的區(qū)間內,效果相對較好�？傮w看,兩種新方法中,SMU新方法Ⅱ的準確性相對較好,與K法準確性相當。新方法Ⅱ對PURE-China基線人群鈉排出量的估計,中國居民人群平均24小時尿鈉排出量水平為5142 mg/天,折合成鹽約相當于13.06 g/天。我國居民鹽攝入水平呈現(xiàn)北方人群高于南方人群,東部高于中西部地區(qū),農村高于城市的趨勢；較高教育文化水平的人群鹽攝入水平低于低教育文化水平人群。高血壓人群鹽攝入水平高于非高血壓人群,但非高血壓人群血壓隨尿鈉排出量的變化幅度,高于高血壓人群。結論：通過隨機尿新方法Ⅰ和SMU新方法Ⅱ利用時點尿對中國居民24小時尿鈉排出量估計的準確性一般,不推薦用于個體尿鈉排出量的衡量,但可適用于人群24小時尿鈉排出量平均水平的估計,以便用于估算人群鈉攝入量。SMU新方法Ⅱ與Kawasaki方法對于估計24小時尿鈉排出量的效果相當。通過新方法Ⅱ估算的24小時尿鈉排出量評價鹽攝入量,我國居民鹽攝入水平非常高,約2.6倍于WHO5 g/天的鹽每日推薦攝入量。
[Abstract]:Background: a large number of studies have shown that sodium intake is closely associated with hypertension. Reducing sodium intake can effectively reduce blood pressure. Some national and international organizations, including the United States, Europe, China, WHO and other international organizations, have proposed the application of salt limiting strategy as an important control of hypertension in relevant documents and clinical guidelines. One of the methods of intervention and the recommended intake of sodium for different populations. The estimated 24 hour urinary sodium excretion (24-hour Urinary Sodium Excretion, 24-h USE) using time point urine is the most commonly used method for estimating the sodium intake level of the population, and the most commonly used is the Kawasaki formula (K), INTERSALT formula (I) and Tanak. A formula (T method). But these three formulas are established in western developed countries. At present, there is still a lack of scientific methods for Chinese residents to estimate 24 hours urine sodium excretion by time point urine. Objective: To evaluate the accuracy of the current methods of estimating urine sodium excretion in 24 hours by time point urine in Chinese residents. In the people, the estimated method of 24 hours urinary sodium excretion was estimated by using non simultaneous urine, and the accuracy of the method was evaluated and the accuracy of this method was evaluated. Method: according to the purpose and design of the study, the method of estimating the urine sodium excretion of the urine by the time point urine of three independent research groups was explored. Among them, the National Cardiovascular Center was in the National Center of cardiovascular disease. In Xishan District, 100 healthy adults (Xishan population) were selected to collect a complete 24 hour urine sample. Each time point urine sample was collected separately, and each time point urine was mixed up as a 24 hour urine sample. At the same time, using the previous research data, that is, the PURE-China urine test group (425) and the application of chronic disease prevention and treatment in the community The data of the urine sample of the project (152 people in Dexing). The two studies only collected the early morning urine sample and 24 hour urine sample. We modeled the urine sodium excretion of the time point urine estimate for 24 hours. In the consideration of the analysis strategy, we first eliminated the data of the research object of 24 hours urine creatinine discharge exceeding the normal range, and then adopted two. 1. (1) a new method of modeling random urine by the Xishan population (77 cases effective analysis) was used as a training sample. PURE-China urine validation population (effective analysis 331 cases) and Dexing population (effective analysis 133 cases) were verified by external data. Analysis of 60 cases, and the internal data validation with a different point urine data set; (2) random sampling (effective analysis of 541 cases) after the combination of three study groups (effective analysis of 541 cases), random sampling (training samples 379 cases, verification samples 162 cases) and second time point urine (Second Morning Urine) in early morning morning. SMU) the new method II, and then the internal data validation. The fitting process is carried out step by step, that is, first through the age, sex, height, weight for 24 hours urine creatinine discharge model fitting, and then according to the time point urine sodium and urine creatinine ratio and 24 hours urine sodium and urine creatinine ratio, through the linear model for the construction of urine sodium excretion of 24 hours. By using the new method of new method of random urine I and SMU new method II, the correlation analysis, the residual analysis, the Bland-Altman method are used to analyze the estimated value of the population and the actual measured values, and the statistical methods such as the deviation distribution analysis between the individual estimated value and the measured value are analyzed, and the new method is carried out with the K, I and T methods. Compare the accuracy of the new method. According to the results of the verification comparison, the new method was used to estimate the 24 hours urine sodium excretion of the PURE-China baseline population, and to evaluate the salt intake and the difference in the salt intake difference between the subgroups of the different groups. Results: according to the two modeling ideas, the time point urine was estimated by the 24 hour urine sodium row. The new method of output is as follows: (1) new method of random urine I: male: PrCRE24h=11.87 * weight +0.417 * height -11.47 x age +832.566 female: PrCRE24h=9.638 * weight -0.085 * height -3.337 x age +490.743e-24-h USE=2.06 X PrUCr24h X (2) new method II: male: male: weight * weight * height - height - 4.683 x age +1498.014 women: PrCRE24h=8.09 * weight +4.417 x height -1.906 x age -159.528e-24-h USE=2.41 x PrUCr24h x (NaSMU/CrSMU) 0.461 injection: e-24-h USE is estimated for 24 hours urine sodium excretion, unit is mg/ day; NaRU is urinary excretion concentration. H is an estimated 24 hour urinary creatinine discharge per unit of mg/ days; the body weight unit is kg, and the average level of the 24 hour urine sodium excretion estimated by the height unit is cm. new method I underestimated 1311 mg/ days, and the deviation (estimated value) is larger; the estimated value is relative deviation from the measured value, that is, the estimated value is (estimated value). The measured value) / measured value is within + 20%, and the absolute deviation (estimated value - measured value) of the individual level of 36.4% is within + 800 mg/ days. The Bland-Altman diagram of the new method I show that the individual estimation value of the horizontal axis is easily overestimated and the individual estimation value on the right is easy to underestimate. The Bland-Altman map shows that the individual estimation value of the SMU sample is scattered between 1.96 times the standard deviation and the estimated value of the urine samples at the rest of the time shows a possible linear trend. The results of the new method I and K, the I method and the T method show that the accuracy of the K method is better. The average level of the urine sodium excretion in the 24 small time urine output estimated by the new method II is compared with the measured value. By underestimating 273 mg/ days, the deviation (estimated value - measured value) is small; 30.8% of the individual level estimation value is relative to the measured value, that is, (estimated value - measured value) / measured value, within + 20%, and the absolute deviation (estimated value - measured value) of the individual level of 32.1% is within + 800 mg/ days; most of the new method II Bland-Altman maps are estimated. As a whole, the accuracy of the new method II of SMU is relatively good and the accuracy of the K method is fairly good. The new method II estimates the sodium excretion of the PURE-China baseline population in the new method of PURE-China, the average 24 hour urine sodium excretion level of the Chinese population is 5142 mg/ days, and the salt is converted into salt. About 13.06 g/ days, the level of salt intake in China is higher than that of the southern population in the north, the East is higher than the central and western regions, the rural is higher than the city. The level of salt intake in the higher education level is lower than that of the low educated people. The salt intake level of the hypertensive population is higher than that of the non hypertensive population, but it is not high blood pressure. The variation of blood pressure with urine sodium excretion is higher than that of hypertensive people. Conclusion: the accuracy of the estimation of 24 hours urine sodium excretion in Chinese residents by using the new method of random urine new method I and SMU II is generally not recommended for the measurement of individual urine sodium excretion, but it can be applied to the average water of the 24 hour urine sodium excretion of the population. The level estimates were used to estimate the effect of the new method for estimating sodium intake.SMU II and the Kawasaki method for the estimated 24 hours urine sodium excretion. The salt intake of the 24 hour urine sodium estimated by the new method II was very high in our country, about 2.6 times the recommended daily salt intake of WHO5 g/ days.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R544.1
，
本文編號：2151022
[Abstract]:Background: a large number of studies have shown that sodium intake is closely associated with hypertension. Reducing sodium intake can effectively reduce blood pressure. Some national and international organizations, including the United States, Europe, China, WHO and other international organizations, have proposed the application of salt limiting strategy as an important control of hypertension in relevant documents and clinical guidelines. One of the methods of intervention and the recommended intake of sodium for different populations. The estimated 24 hour urinary sodium excretion (24-hour Urinary Sodium Excretion, 24-h USE) using time point urine is the most commonly used method for estimating the sodium intake level of the population, and the most commonly used is the Kawasaki formula (K), INTERSALT formula (I) and Tanak. A formula (T method). But these three formulas are established in western developed countries. At present, there is still a lack of scientific methods for Chinese residents to estimate 24 hours urine sodium excretion by time point urine. Objective: To evaluate the accuracy of the current methods of estimating urine sodium excretion in 24 hours by time point urine in Chinese residents. In the people, the estimated method of 24 hours urinary sodium excretion was estimated by using non simultaneous urine, and the accuracy of the method was evaluated and the accuracy of this method was evaluated. Method: according to the purpose and design of the study, the method of estimating the urine sodium excretion of the urine by the time point urine of three independent research groups was explored. Among them, the National Cardiovascular Center was in the National Center of cardiovascular disease. In Xishan District, 100 healthy adults (Xishan population) were selected to collect a complete 24 hour urine sample. Each time point urine sample was collected separately, and each time point urine was mixed up as a 24 hour urine sample. At the same time, using the previous research data, that is, the PURE-China urine test group (425) and the application of chronic disease prevention and treatment in the community The data of the urine sample of the project (152 people in Dexing). The two studies only collected the early morning urine sample and 24 hour urine sample. We modeled the urine sodium excretion of the time point urine estimate for 24 hours. In the consideration of the analysis strategy, we first eliminated the data of the research object of 24 hours urine creatinine discharge exceeding the normal range, and then adopted two. 1. (1) a new method of modeling random urine by the Xishan population (77 cases effective analysis) was used as a training sample. PURE-China urine validation population (effective analysis 331 cases) and Dexing population (effective analysis 133 cases) were verified by external data. Analysis of 60 cases, and the internal data validation with a different point urine data set; (2) random sampling (effective analysis of 541 cases) after the combination of three study groups (effective analysis of 541 cases), random sampling (training samples 379 cases, verification samples 162 cases) and second time point urine (Second Morning Urine) in early morning morning. SMU) the new method II, and then the internal data validation. The fitting process is carried out step by step, that is, first through the age, sex, height, weight for 24 hours urine creatinine discharge model fitting, and then according to the time point urine sodium and urine creatinine ratio and 24 hours urine sodium and urine creatinine ratio, through the linear model for the construction of urine sodium excretion of 24 hours. By using the new method of new method of random urine I and SMU new method II, the correlation analysis, the residual analysis, the Bland-Altman method are used to analyze the estimated value of the population and the actual measured values, and the statistical methods such as the deviation distribution analysis between the individual estimated value and the measured value are analyzed, and the new method is carried out with the K, I and T methods. Compare the accuracy of the new method. According to the results of the verification comparison, the new method was used to estimate the 24 hours urine sodium excretion of the PURE-China baseline population, and to evaluate the salt intake and the difference in the salt intake difference between the subgroups of the different groups. Results: according to the two modeling ideas, the time point urine was estimated by the 24 hour urine sodium row. The new method of output is as follows: (1) new method of random urine I: male: PrCRE24h=11.87 * weight +0.417 * height -11.47 x age +832.566 female: PrCRE24h=9.638 * weight -0.085 * height -3.337 x age +490.743e-24-h USE=2.06 X PrUCr24h X (2) new method II: male: male: weight * weight * height - height - 4.683 x age +1498.014 women: PrCRE24h=8.09 * weight +4.417 x height -1.906 x age -159.528e-24-h USE=2.41 x PrUCr24h x (NaSMU/CrSMU) 0.461 injection: e-24-h USE is estimated for 24 hours urine sodium excretion, unit is mg/ day; NaRU is urinary excretion concentration. H is an estimated 24 hour urinary creatinine discharge per unit of mg/ days; the body weight unit is kg, and the average level of the 24 hour urine sodium excretion estimated by the height unit is cm. new method I underestimated 1311 mg/ days, and the deviation (estimated value) is larger; the estimated value is relative deviation from the measured value, that is, the estimated value is (estimated value). The measured value) / measured value is within + 20%, and the absolute deviation (estimated value - measured value) of the individual level of 36.4% is within + 800 mg/ days. The Bland-Altman diagram of the new method I show that the individual estimation value of the horizontal axis is easily overestimated and the individual estimation value on the right is easy to underestimate. The Bland-Altman map shows that the individual estimation value of the SMU sample is scattered between 1.96 times the standard deviation and the estimated value of the urine samples at the rest of the time shows a possible linear trend. The results of the new method I and K, the I method and the T method show that the accuracy of the K method is better. The average level of the urine sodium excretion in the 24 small time urine output estimated by the new method II is compared with the measured value. By underestimating 273 mg/ days, the deviation (estimated value - measured value) is small; 30.8% of the individual level estimation value is relative to the measured value, that is, (estimated value - measured value) / measured value, within + 20%, and the absolute deviation (estimated value - measured value) of the individual level of 32.1% is within + 800 mg/ days; most of the new method II Bland-Altman maps are estimated. As a whole, the accuracy of the new method II of SMU is relatively good and the accuracy of the K method is fairly good. The new method II estimates the sodium excretion of the PURE-China baseline population in the new method of PURE-China, the average 24 hour urine sodium excretion level of the Chinese population is 5142 mg/ days, and the salt is converted into salt. About 13.06 g/ days, the level of salt intake in China is higher than that of the southern population in the north, the East is higher than the central and western regions, the rural is higher than the city. The level of salt intake in the higher education level is lower than that of the low educated people. The salt intake level of the hypertensive population is higher than that of the non hypertensive population, but it is not high blood pressure. The variation of blood pressure with urine sodium excretion is higher than that of hypertensive people. Conclusion: the accuracy of the estimation of 24 hours urine sodium excretion in Chinese residents by using the new method of random urine new method I and SMU II is generally not recommended for the measurement of individual urine sodium excretion, but it can be applied to the average water of the 24 hour urine sodium excretion of the population. The level estimates were used to estimate the effect of the new method for estimating sodium intake.SMU II and the Kawasaki method for the estimated 24 hours urine sodium excretion. The salt intake of the 24 hour urine sodium estimated by the new method II was very high in our country, about 2.6 times the recommended daily salt intake of WHO5 g/ days.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R544.1
，
本文編號：2151022
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