尿L-FABP与2型糖尿病患者肾功能变化的纵向研究  

Longitudinal study on relationship of urinary L-FABP with renal function in type 2 diabetes mellitus patients

作　　者：朱珍[1] 祝超瑜[1] 高清歌[1] 徐立[1] 喻晶[1] 蒋伏松[1] 魏丽[1] 

机构地区：[1]上海市交通大学附属第六人民医院内分泌代谢科,上海201306

出　　处：《中华老年多器官疾病杂志》2015年第5期335-341,共7页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：上海市浦东新区卫生系统重点学科群建设基金（PWZxq2014-07）

摘　　要：目的 尿肝脏型脂肪酸结合蛋白（L-FABP）是早期预测急性和慢性肾功能损伤的优良生物学标志物.本项研究旨在前瞻性地探讨尿L-FABP水平预测2型糖尿病患者肾病进展及估算的肾小球滤过率（eGFR）下降率的价值.方法 对2010年1月至2012年6月于我院内分泌科住院的288名2型糖尿病患者进行分组（正常尿白蛋白组、微量尿白蛋白组、大量尿白蛋白组）并随访2年,测定各组随访前后尿L-FABP水平、尿白蛋白排泄率（UAER）和eGFR.结果 随着研究的进展,微量尿白蛋白组和大量尿白蛋白组随访后的L-FABP水平均高于随访前水平（P＜0.05）,而仅大量白蛋白尿组随访后的UAER高于随访前水平（P＜0.05）.Pearson线性相关分析结果显示：随访前,大量尿白蛋白组和微量尿白蛋白组的尿L-FABP水平与UAER均呈显著正相关（分别为r=0.573,r=0.219;P＜ 0.05）;随访后,大量尿白蛋白组和微量尿白蛋白组的尿L-FABP水平亦均与UAER呈显著正相关（分别为r=0.689,r=0.203;P＜0.05）.多元逐步回归分析结果提示,随访前和随访后大量尿白蛋白组尿L-FABP水平与eGFR变化率显著相关（分别为β=-0.397,t=-4.376;β=-0.455,t=-4.854;P＜0.05）;随访前和随访后微量尿白蛋白组的尿L-FABP水平与eGFR变化率亦显著相关（分别为β=-0.327,t=-2.987;β=-0.378,t=-4.298;P＜0.05）.结论 尿L-FABP水平与糖尿病患者的肾功能相关,动态监测尿L-FABP可早期预测2型糖尿病肾病的进展.尿L-FABP可能早期独立预测2型糖尿病肾病患者的eGFR下降情况.Objective Urine liver-type fatty acid binding protein （L-FABP） is emerging as an excellent biomarker for the early prediction of acute and chronic kidney injury. The aim of this prospective study was to determine the value of urine L-FABP in predicting the progression of nephropathy and the decline of estimated glomerular filtration rate （eGFR） in type 2 diabetic patients. Methods A longitudinal cohort study was conducted on 288 type 2 diabetic patients for 2 consecutive years, who were admitted to Department of Endocrinology of our hospital during January 2010 to June 2012. They were divided into normo-, micro- and macro-albuminuria groups according to their 24h-urinary albumin excreting rate （UAER）. Urine levels of L-FABP, and UAER were determined. Results The follow-up levels of urinary L-FABP in both the micro- and macro-albuminuria groups were significantly higher than their baseline levels （P 〈 0.05）, but only the macro-albuminuria group had the level of UAER higher than its baseline （P 〈 0.05）. The results of Pearson correlations showed that urine L-FABP was correlated with UAER in the micro- and macro-albuminuria groups at both before and after follow-up （before： r = 0.573, r = 0.219, P〈 0.05; after： r---0.689, r = 0.203, P〈 0.05）. Multivariate stepwise regression analysis indicated that the urinary L-FABP levels before and after follow-up were significantly correlated with eGFR decline rate in both the macro- and micro-albuminuria groups （macro-albuminuria group： β=-0.397, t =-4.376, β=-0.455, t =-4.854, P 〈 0.05; micro-albuminuria group： β=-0.327, t =-2.987, β =-0.378, t =-4.298, P 〈 0.05）. Conclusion Urine L-FABP iscorrelated with renal function in the patients with type 2 diabetes mellitus, and its dynamic monitoring may predict the progression of diabetic nephropathy. Urine L-FABP may independently predict the early decline of eGFR in type 2 diabetic nephropathy patients.

关 键 词：糖尿病肾病 肝脏型脂肪酸结合蛋白 尿白蛋白排泄率 肾小球滤过率 

分 类 号：R587.1[医药卫生—内分泌]