孙怡，伯坚，彭亚光，侯彦，陈辉，王兴宇，尹潞，王杨，刘远立，李卫，代表PURE-China课题协作组

临床研究

利用三种点尿估算方法评估和验证中国人群24小时尿钠排泄量

孙怡，伯坚*，彭亚光，侯彦，陈辉，王兴宇，尹潞，王杨，刘远立，李卫，代表PURE-China课题协作组

目的: 本研究旨在验证和评价Kawasaki、INTERSALT和Tanaka三种方法估算24 h尿钠排泄量在中国人群中应用的可行性和准确性。

方法：本研究是前瞻性城乡流行病学研究（PURE）的子研究，抽取120名受试者（城乡各60名），同时收集受试者的空腹晨尿和24 h尿液标本，检测点尿和24 h尿液中钠、钾和肌酐水平。使用Bland-Altman法比较三种方法所估算出的24 h尿钠排泄量和实际尿钠排泄量之间的一致性。

结果: 最终116 名受试者被纳入到最终的统计分析。实测钠排泄的平均值为6 343 mg/d（约为盐16.2 g/d）。Kawasaki法是3种方法中偏差最小的，平均偏差值（估测值减24 h实际观察值)为-740.49 mg/d。Tanaka法的平均偏差值是-2 305.05 mg/d。差距最大的是INTERSALT法，平均偏差值为-2 797.39 mg/d。尽管与其他方法相比，Kawasaki法的估测值与24 h实测值之间的差距较小，Bland-Altman图显示仍有9人（7.76%）超出均数±1.96倍标准差的一致性界线。

结论：Kawasaki法、INTERSALT法和Tanaka法三种方法估算中国城乡人群的24 h尿钠排泄量均存在不同程度的低估和局限，故需制定一个适合中国人群的估算24 h尿钠排泄量方法，从而更准确地评估中国人群的盐摄入量。

尿钠排泄；24 h尿；时点尿

Objective: To validate and evaluate the feasibility and accuracy of 24-hour urinary sodium excretion (USE) in Chinese population by 3 estimating approaches of Kawasaki, INTERSALT and Tanaka methods.

Methods: Our research was a sub-study of “prospective urban rural epidemiology (PURE)”. A total of 120 participants were selected including 60 from urban and 60 from rural areas. Morning fasting urine and 24-hour urine specimens were collected to examine the levels of sodium, potassium and creatinine in each participant. The consistencies between estimated 24-hour USE and real measured 24-hour USE were compared by Bland-Altman plots in each method respectively.

Results: There were 116 participants were enrolled for fnal analysis. The mean level of sodium excretion was 6343 mg/day (about 16.2 g/day of salt). Among 3 methods, Kawasaki method had the minimum mean exponent bias (estimated 24-hour USE minus real measured 24-h USE) as -740 mg/day, the mean exponent bias in Tanaka method was -2305 mg/day, in INTERSALT method was -2797 mg/day which was the maximum. Although Kawasaki method had the minimum mean exponent bias, Bland-Altman plots showed that the differences in 9 (7.8%) patients were still beyond the mean ±1.96 standard deviation.

Conclusion: Kawasaki, INTERSALT and Tanaka methods have underestimation and limitation for evaluating 24-hourUSE in Chinese population; it is necessary to develop a suitable method for measuring 24-hour USE in order to assess the salt intake amount in Chinese population.

(Chinese Circulation Journal, 2016,31:1115.)

大量研究表明，日常饮食中的高钠摄入与高血压、冠心病、中风等疾病发生有很大程度的关联性[1-7]。虽然一些指南制定了钠盐摄入的建议用量[8，9]，但仍存在一定争议。因此，有必要在人群调查中对钠摄入量进行测量。……