尿肝型脂肪酸结合蛋白与糖尿病肾病进展的关系研究

Study on the relationship of urinary liver-type fatty-acid binding protein and progression of nephropathy in diabetic patients

目的：探讨尿肝型脂肪酸结合蛋白（ L-FABP）与糖尿病肾病进展的关系。方法选择1型和2型糖尿病患者132例，依据尿蛋白/肌酐比（ACR）和血清肌酐水平分为正常蛋白尿组（45例），微量蛋白尿组（36例），临床白蛋白尿组（30例），肾功能衰竭组（21例），以65例健康体检者为对照组，酶联免疫吸附法（ ELISA ）测定尿L-FABP含量，同时检测血肌酐（Scr）、尿肌酐、肝功能、血红蛋白、糖化血红蛋白（HbA1c）、白蛋白（Alb）、24 h尿蛋白量、尿白蛋白等指标。结果随着糖尿病肾病的进展，尿L-FABP水平逐渐增高（各组间比较P ＜0.01），亚组分析显示正常白蛋白组尿L-FABP水平高于健康组（ P＜0.05），微量白蛋白组尿L-FABP水平高于正常白蛋白组（ P ＜0.01），临床白蛋白组尿L-FABP水平高于微量白蛋白组（ P＜0.01），肾功能衰竭组尿L-FABP水平高于临床白蛋白组（ P ＜0.01）；尿L-FABP水平与估计肾小球滤过率（ eGFR ）呈负相关（ r ＝-0.812， P ＜0.01），尿L-FABP水平与Scr呈正相关（ r ＝0.901， P ＜0.01），与HbA1c无关（ P ＞0.05）。结论尿L-FABP水平不但可以更早预测糖尿病肾病的发生，还可以监测糖尿病肾病的进展。

Objective To investigate the relationship of urinary liver-type fatty-acid binding protein and progression of ne-phropathy in diabetic patients .Methods A total of 132 cases of type 1 and type 2 diabetic patients were recruited in this study , and were divided into four groups based on the urine albumin /creatinine and serum creatinine levels , including normal albuminuria group （ n =45）, microalbuminuria group （ n =36）, clinical albuminuria group （ n =30）, and renal failure group （ n =21）, Additional 65 healthy subjects were recruited as control group .The levels of urinary liver-type fatty-acid binding protein （ L-FABP） were measured with enzyme-linked immunosorbent assay （ELISA）, and serum creatinine, urine creatinine, Liver function, hemoglobin, glycated he-moglobin （HbA1c）, albumin （Alb）, and 24h urinary protein were measured by respective biochemical or immunological methods . Results With the progression of diabetic nephropathy , the level of urinary L-FABP was gradually increased （ P ＆lt;0.01 ） , subgroup analysis showed that the level of urine L-FABP of normal albuminuria group was significantly higher than that of healthy group （ P ＆lt;0.05 ） .The level of urine L-FABP of microalbuminuria group was significantly higher than that of normal albuminuria group （ P ＆lt;0.01 ） .The level of urine L-FABP of clinical albuminuria group was significantly higher than that of microalbuminuria group （ P ＆lt;0.01 ） .The level of urine L-FABP of renal failure group was significantly higher than that of clinical albuminuria group （ P ＆lt;0.01 ） . The levels of urinary L-FABP was negatively correlated with estimated glomerular filtration rate （ eGFR） （ r =-0.812 , P ＆lt;0.01 ） , was positively correlated with Scr （ r =0.901, P ＆lt;0.01）, and was no correlation with HbA1c （ P ＆gt;0.05）.Conclusions The uri-nary L-FABP level can predict the occurrence of early diabetic nephropathy , and also monitor the progression of diabetic nephropathy .