尿肝型脂肪酸结合蛋白预测慢性肾小球肾炎进展的价值  

Value of urinary liver-type fatty acid binding protein in prediction of renal function progression in patients with chronic glomerulonephritis

作　　者：徐维佳[1] 李佳琳[1] 王琴[1] 施蓓莉[1] 牟姗[1] 倪兆慧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾内科,200127

出　　处：《中华肾脏病杂志》2012年第4期272-275,共4页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81102700）;教育部留学回国人员科研启动基金（教外司留[2010]1174号）;973课题（2012CB517602）;上海市科委中医药现代化专项资金（09dZ1973600）;上海市科委基础重点项目（10JC1410100）;上海市卫生局科研基金（2010L063A）

摘　　要：目的评估尿肝型脂肪酸结合蛋白（L-FABP）预测慢性肾小球肾炎（CGN）病情进展的临床价值。方法前瞻性人选2004年1月至2005年12月期间在我院行肾穿刺活检明确病理诊断的原发性CGN患者123例为对象，另选28例年龄、性别匹配的健康志愿者为对照。用酶联免疫吸附法检测肾穿刺前新鲜尿液L-FABP含量，同时常规检测各项血液及尿液指标。对所有患者进行5年随访，每3个月随访1次，在随访结束时分为疾病进展组和非进展组，评估影响CGN进展的危险因素。结果与对照组相比，CGN患者尿L-FABP均值明显升高（P〈0．01）。尿L-FABP与估计肾小球滤过率（eGFR）呈负相关（r=-0．565，P〈0．01）；与尿蛋白量（r=0．501，P〈0．01）和Scr（r=0．601，P〈0．01）呈正相关。Kaplan-Meier分析显示，尿L-FABP〉76．58μg/g·cr的CGN患者的预后显著变差。尿L-FABP预测CGN进展的ROC曲线下面积（AUC）为0．95。尿L-FABP为119．8μg／g·cr时，其敏感性为87．5％，特异性为90．5％。结论尿L-FABP可作为监测慢性。肾小球肾炎疾病进展的新生物学标记物。Objective To evaluate the value of urinary liver-type fatty acid binding protein （L-FABP）as a biomarker in prediction of renal function progression in patients with chronic glomerulonephritis （CGN）. Methods A total of 123 patients with newly diagnosed CGN by renal biopsy in Shanghai Renji Hospital between 2004 January and 2005 December were enrolled in the study. Twenty-eight healthy subjects were used as control group. Urine samples were collected before biopsy and treatment, and urinary L-FABP was measured by ELISA. The patients with follow-up every three months for 5 years were divided into progressive group and non- progressive group. The progression of kidney function impairment was defined as a reduction of GFR≥ 5 ml·min^-1·（1.73 m2）^-1 ·ear^-1 during follow-up. The risk factors of progressive renal function were evaluated and the Spearman correlation analysis was performed to find out the prognostic indicator of renal function deterioration. Results Urinary L-FABP level of CGN patients was significantly higher than that of healthy control group （P〈0.01）. Urinary L-FABP in CGN patients was negatively correlated with eGFR （r=-0.565, P〈 0.01） and positively correlatedwith proteinuria （r=0.501, P〈0.01） and Scr （r=0.601, P〈0.01）. Kaplan-Meier analysis showed that urinary L-FABP excretion 〉76.58μg/g ·cr predicted progression of renal function. The AUC of urinary L-FABP for prognosis of CGN progression was 0.95, with 87.5% of sensitivity and 90.5% of specificity at the cutoff value of 119.8 μg/g·cr, which revealed its great value of predicting the prognosis of CGN patients. Conclusion Urinary L-FABP can be a novel biomarker of evaluation for renal injury and early progressive renal function deterioration in patients with CGN.

关 键 词：脂肪酸结合蛋白质类 肾小球肾炎 生物学标记 

分 类 号：R692.3[医药卫生—泌尿科学]