Abstract: Background　Microalbuminuria（MAU）is one of the markers of early renal damage in hypertension．　The urine albumin-to-creatinine ratio（ACR）has been recommended as the first choice for the detection of MAU．At present，the main detection methods of ACR include radioimmunoassay，chemiluminescence immunoassay and immunoturbidimetric assay．But these methods need special instruments and equipment as well as professional inspectors to implement，which can not be used in primary medical institutions and epidemiological investigations．Identifying a simple method to measure MAU is helpful to evaluate early renal damage in hypertensive primary care patients，and may provide an efficient tool for related epidemiological investigation．Semi-quantitative urine strip is a simple and inexpensive method for rapidly detecting MAU，which has been recommended for clinical efficacy monitoring in primary care，patient home monitoring and epidemiological investigation．However，the domestic research is less at present．Objective　The study aimed to evaluate the clinical accuracy and application value of semi-quantitative urine strip in screening for MAU，comparing with the result predicted by ACR measured by using immunoturbidimetric assay．Methods　284 hypertensive patients（aged 18-85 years）without a history of using antihypertensive drugs were recruited from Heart Center，Peking University People's Hospital from November 2016 to August 2017．Their urine samples were collected and tested with immunoturbidimetry and semi-quantitative urine strip separately for ACR．The accuracies of five categories ACR values（30-300 mg/g，50-300 mg/g，80-300 mg/g，100-300 mg/g，150-300 mg/g）tested by semi-quantitative urine strip for the diagnosis of MAU were estimated by comparing with the accuracy of ACR tested by immunoturbidimetry（the gold standard for screening MAU）in terms of sensitivity，specificity，rate of omitted diagnosis，misdiagnosis rate，Youden index and positive likelihood ratio．Results Of the five categories of ACR values for diagnosing MAU，ACR value of 100-300 mg/g had the largest Youden index（6.83%）and positive likelihood（1.25），ACR value of 150-300 mg/g had the highest specificity（75.61%）and lowest misdiagnosis rate（24.39%）．Conclusion　ACR value of 100-300 mg/g detected by semi-quantitative urine strip can be used as a semi-quantitative method for the diagnosis of MAU，which may be a tool for effectively screening for MAU in primary care with certain clinical application value．

Key words: Albuminuria, Hypertension, Albumin-to-creatinine ratio, Semi-quantitative urine strip

摘要： 背景　微量白蛋白尿（MAU）是高血压肾脏早期损害的标志之一，尿微量白蛋白/肌酐（ACR）已被推荐作为MAU的首选检测方法。目前检测ACR的主要方法包括放射免疫法、化学发光免疫分析法、免疫比浊法等，均需要特殊的仪器和设备以及专业的检验人员才能实施，不能应用于基层以及流行病学调查中。寻找简易MAU的测定方法，有助于基层评估高血压早期肾脏损害，并可能为相关的流行病学调研提供方法。半定量试纸法作为一种快速简便、经济的MAU检测方法，已被推荐用于基层的疗效监测、患者家庭监测以及流行病学调查，但目前国内相关研究较少。目的　本研究以免疫比浊法检测的尿ACR作为金标准，评估半定量试纸法检测MAU的准确度及临床应用价值。方法　选取2016年11月—2017年8月在北京大学人民医院心脏中心就诊的未服降压药18~85岁高血压患者284例为研究对象，以免疫比浊法测定的ACR结果作为金标准，分别以半定量试纸法测定的ACR结果 30~300 mg/g（标准一）、50~300 mg/g（标准二）、80~300 mg/g（标准三）、100~300 mg/g（标准四）、150~300mg/g（标准五）作为MAU的阳性诊断标准，计算不同阳性诊断标准下半定量试纸法检测MAU的灵敏度、特异度、漏诊率、误诊率、Youden指数及阳性似然比。结果　与半定量试纸法ACR 30~300 mg/g、50~300 mg/g、80~300 mg/g以及150~300 mg/g的切点相比，ACR 100~300 mg/g的Youden指数及阳性似然比最优，分别为6.83%及1.25。同时，半定量试纸法ACR 150~300 mg/g的特异度（75.61%）最高，误诊率（24.39%）最低。结论　半定量试纸法检测的ACR 100~300 mg/g可作为MAU的半定量阳性诊断标准，是一种可用于基层筛查MAU的有效工具，具有一定的临床应用价值。

关键词: 白蛋白尿, 高血压, 尿微量白蛋白/肌酐, 半定量试纸法