利用时点尿估算中国人群24小时尿钠排出量方法的探索性及适用性评价研究
发布时间：2018-07-28 17:18
【摘要】：背景：目前大量研究表明,钠盐摄入与高血压密切关联,减少钠的摄入可以有效降低血压水平。包括美国、欧洲、中国、世界卫生组织等一些国家地区和国际组织都在相关文件或临床指南中提出了将限盐策略作为控制高血压的重要生活方式干预手段之一,并且给出了针对不同人群膳食钠的推荐摄入量。利用时点尿估算24小时尿钠排出(24-hour Urinary Sodium Excretion,24-h USE)是比较常用的估算人群钠摄入水平的方法,目前最为常用的是Kawasaki公式(K法)、INTERSALT公式(I法)和Tanaka公式(T法)。但这三种公式均是以西方发达国家人群数据建立的,目前尚缺乏针对中国居民,利用时点尿估算24小时尿钠排出量的科学方法。目的：评价时点尿估算24小时尿钠排出量现有常用方法在中国居民人群中准确性。在中国正常居民中,利用不同时点尿估算24小时尿钠排出量,探索适用于中国居民的估算方法,并评价该方法的准确性。方法：本研究根据研究目的和设计方案,通过三项独立研究人群探索时点尿估算24小时尿钠排出量方法。其中,在国家心血管病中心西山院区入选100名相对健康成年人群(西山人群),收集完整24小时尿样本,各次时点尿样本均单独采集,并将各次时点尿混匀作为24小时尿样本。同时利用以往的研究数据,即PURE-China尿验证人群(425名)和慢性病防治适宜技术在社区的应用项目部分尿样本数据(德兴人群152名),上述两项研究仅采集清晨时点尿样本和24小时尿样本。对时点尿估算24小时尿钠排出量进行建模探讨。在考虑分析策略时,首先剔除24小时尿肌酐排出量超过正常值范围的研究对象数据,而后采取两种建模思路,分步进行拟合。(1)由西山人群(有效分析77例)作为训练样本建模随机尿新方法Ⅰ,PURE-China尿验证人群(有效分析331例)和德兴人群(有效分析133例)进行外部数据验证。而后对西山人群数据进行不同时点尿分组比较分析(有效分析60例),并用不同时点尿数据集进行内部数据验证；(2)以三项研究人群合并后重新随机抽样(有效分析541例),按照训练样本与验证样本7：3比例进行随机抽样(训练样本379例,验证样本162例),建模清晨晨起第二次时点尿(Second Morning Urine, SMU)新方法Ⅱ,而后进行内部数据验证。拟合过程分步进行,即先通过年龄、性别、身高、体重进行24小时尿肌酐排出量的模型拟合,再根据时点尿钠和尿肌酐比值与24小时尿钠和尿肌酐比值的关联,通过线性模型进行24小时尿钠排出量的建模拟合。通过随机尿新方法Ⅰ和SMU新方法Ⅱ对人群估计值与实际测量值之间采用相关分析、残差分析、Bland-Altman法进行验证分析,并分析个体估计值与实测值之间偏差分布分析等统计学方法进行评价,同时将新方法与K法、I法和T法进行比较,评价新方法的准确性。根据验证比较结果,利用新方法对PURE-China基线人群进行24小时尿钠排出量估计,并评价盐摄入量,以及在不同人群亚组之间盐摄入量差异的比较。结果：根据两种建模思路,所构建的时点尿估算24小时尿钠排出量的新方法如下：(1)随机尿新方法Ⅰ：男性：PrCRE24h=11.87×体重+0.417×身高-11.47×年龄+832.566女性：PrCRE24h=9.638×体重-0.085×身高-3.337×年龄+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×体重-3.567×身高-4.683×年龄+1498.014女性：PrCRE24h=8.09×体重+4.417×身高-1.906×年龄-159.528e-24-h USE=2.41×PrUCr24h×(NaSMU/CrSMU)0.461注：e-24-h USE为估计的24小时尿钠排出量,单位为mg/天；NaRU为RU尿钠排出浓度,单位为ng/dL;CrRU为RU尿肌酐排出浓度,单位为mg/dL;PrUCr24h为估计的24小时尿肌酐排出量,单位为mg/天；体重单位为kg,身高单位为cm。新方法Ⅰ估计的24小时尿钠排出量人群均值水平与实测值相比,低估1311 mg/天,偏差(估计值-实测值)较大；有30.6%的个体水平估计值与实测值相对偏差,即(估计值-实测值)/实测值,在±20%以内,36.4%的个体水平估计值绝对偏差(估计值-实测值)在±800 mg/天以内；新方法Ⅰ的Bland-Altman图呈现横轴相对左侧的个体估计值易高估,右侧的个体估计值易低估的趋势。在利用不同时点尿样本进行新方法Ⅰ验证时,Bland-Altman图显示SMU样本个体估计值在1.96倍标准差之间散在分布,其余各时点尿样本估计值呈现可能的线性趋势。新方法I与K法、I法和T法比较结果显示,K法准确性较好。新方法Ⅱ估计的24小时尿钠排出量人群均值水平与实测值相比,低估273 mg/天,偏差(估计值-实测值)较小；有30.8%的个体水平估计值与实测值相对偏差,即(估计值-实测值)/实测值,在±20%以内,32.1%的个体水平估计值绝对偏差(估计值-实测值)在±800 mg/天以内；新方法Ⅱ的Bland-Altman图大部分个体估计值散在分布在±1.96倍标准差的区间内,效果相对较好。总体看,两种新方法中,SMU新方法Ⅱ的准确性相对较好,与K法准确性相当。新方法Ⅱ对PURE-China基线人群钠排出量的估计,中国居民人群平均24小时尿钠排出量水平为5142 mg/天,折合成盐约相当于13.06 g/天。我国居民盐摄入水平呈现北方人群高于南方人群,东部高于中西部地区,农村高于城市的趋势；较高教育文化水平的人群盐摄入水平低于低教育文化水平人群。高血压人群盐摄入水平高于非高血压人群,但非高血压人群血压随尿钠排出量的变化幅度,高于高血压人群。结论：通过随机尿新方法Ⅰ和SMU新方法Ⅱ利用时点尿对中国居民24小时尿钠排出量估计的准确性一般,不推荐用于个体尿钠排出量的衡量,但可适用于人群24小时尿钠排出量平均水平的估计,以便用于估算人群钠摄入量。SMU新方法Ⅱ与Kawasaki方法对于估计24小时尿钠排出量的效果相当。通过新方法Ⅱ估算的24小时尿钠排出量评价盐摄入量,我国居民盐摄入水平非常高,约2.6倍于WHO5 g/天的盐每日推荐摄入量。
[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.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R544.1
，
本文编号：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.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R544.1
，
本文编号：2151022
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