2型糖尿病肾病患者尿肝型脂肪酸结合蛋白水平的临床意义

Clinical significance of urinary liver-type fatty binding protein levels in type2 diabetic nephropathy

目的探讨检测尿肝型脂肪酸结合蛋白（L-FABP）水平对2型糖尿病肾病的临床意义。方法根据24 h尿蛋白排泄率（UAER）将89例2型糖尿病肾病患者分成三组：单纯2型糖尿病组（Ⅰ组）30例（UAER＜30 mg/24 h）、早期2型糖尿病肾病组（Ⅱ组）29例（UAER 30～300 mg/24 h）和临床2型糖尿病肾病组（Ⅲ组）30例（UAER＞300 mg/24 h）。并选择30例体检者作对照组（NC组），采用酶联免疫吸附试验（ELISA）法测定其尿L-FABP水平，并检测血肌酐（Scr）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）等指标，及估测肾小球滤过率估算值（eGFR），同时分析尿L-FABP与脂蛋白的相关性。结果Ⅰ组、Ⅱ组和Ⅲ组的尿L-FABP和UAER（24 h）水平均明显高于NC组，差异均有统计学意义（t分别=1.94、2.32、2.77、2.04、2.89、3.41， P均＜0.05），Ⅱ组及Ⅲ组尿L-FABP和UAER（24 h）水平均高于Ⅰ组，差异均有统计学意义（t 分别=2.22、3.65、2.88、4.12， P均＜0.05）；Ⅲ组尿L-FABP和UAER（24 h）水平均高于Ⅱ组，差异均有统计学意义（t分别=3.11、3.48， P均＜0.05）。Ⅰ组、Ⅱ组和Ⅲ组的Scr、TC、TG、HDL-C水平均明显高于NC组，eGFR水平均低于NC组，差异均有统计学意义（t分别=2.48、2.89、3.18、2.55、2.92、3.67、2.62、2.78、3.24、2.39、2.68、2.99、2.64、3.58、4.67， P均＜0.05）。尿L-FABP水平与Scr和尿白蛋白呈明显性正相关（r=0.39、0.54，P均＜0.05），与eGFR呈明显负相关（r=-0.66，P＜0.05）。结论尿L-FABP对2型糖尿病肾病有较高的敏感性，提示其是较好的诊断标记物之一。

Objective To investigate the clinical significance of urinary liver-type fatty binding protein（L-FABP） levels of type2 diabetic nephropathy（DN）. Methods A total of 89 patients with DN were randomly divided into 3 groups by 24-hour urine protein excretion rate（UAER）：pure type2 diabetes group as groupⅠwhose UAER was lower than 30 mg per 24 hours, early type2 diabetic nephropathy group as group Ⅱ whose UAER was between 30 and 300 mg per 24 hours and clinical type2 diabetic nephropathy group as groupⅢwhose UAER was higher than 300 mg per 24 hours. 30 healthy vol-unteers were selected as controls. Urinary L-FABP levels were measured by ELISA and the levels of Scr, TC, TG, LDL-C, HDL-C and GFR estimate were detected. The correlation between urinary L-FABP and lipoprotein was analyzed. Re-sults Urinary L-FABP levels and UAER of DN patients were significantly higher than the control group （t=1.94, 2.32, 2.77, 2.04, 2.89, 3.41,P〈0.05）.Urinary L-FABP levels and UAER of group Ⅱ and Ⅲ were significantly higher than group I（t=2.22, 3.65, 2.88, 4.12,P〈0.05）. Urinary L-FABP levels and UAER of groupⅢwere significantly higher than group Ⅱ （t=3.11, 3.48,P〈0.05）. The levels of Scr, TC, TG, HDL-C in DN patients were significantly higher than the control group, while the eGFR level were significantly lower than the control group（t=2.48, 2.89, 3.18, 2.55, 2.92, 3.67, 2.62, 2.78, 3.24, 2.39, 2.68, 2.99, 2.64, 3.58, 4.67, P〈0.05）. Urinary L-FABP was positive related to Scr and uri-nary protein （r=0.39, 0.54, P〈0.05） while was negative related to eGFR （r=-0.66,P〈0.05）. Conclusion Urinary L-FABP have high sensitivity to type2 DN. It might be a novel diagnostic marker for DN.