糖尿病肾病患者尿L-FABP的检测及其临床意义

Detection of Urinary L-FABP and Its Clinical Significance in Patients with Diabetic Nephropathy

目的:探讨尿肝型脂肪酸结合蛋白(L-FABP)在糖尿病肾病早期诊断和预测糖尿病肾病病情进展的临床价值。方法:收集2011年1-10月期间在我院内分泌科确诊的2型糖尿病患者133例为对象,另选40例年龄、性别匹配的健康体检者为正常对照组。应用酶联免疫吸附法检测其尿液L-FABP含量,同时检测血肌酐(Scr)、肾小球滤过率(GFR)、空腹血糖(FPG)和胰岛素(INS)。结果:与正常对照组相比,糖尿病患者尿L-FABP水平明显升高(P<0.01),且随尿蛋白排泄率增加而尿L-FABP水平逐渐升高,并与血脂代谢和胰岛素抵抗等致病因素密切相关。尿L-FABP预测糖尿病肾病进展的ROC曲线下面积(AUC)为0.85,尿L-FABP为33.2μg/(g·Cr)时,其敏感性为85.5%,特异性为87.4%。尿L-FABP与估计肾小球滤过率(eGFR)呈负相关(r=-0.641,P<0.01),与Scr(r=0.714,P<0.01)呈正相关。结论:尿L-FABP可作为糖尿病肾病早期诊断及预测糖尿病肾病病情进展的新型生物标志物。

Objective：To study the value of urinary liver-type fatty acid bindingprotein（L-FABP）as a biomarker in early diagnose and prediction progression of diabetic nephropathy in diabetic patients.Methods：A total of 133 patients diagnosed diabete in department of Endocrinology of Wuhan Central Hospital between 2011 January and 2011 October were enrolled in the study.Forty healthy subjects were used as control group.To obtain serum and urinary samples of studied objects,urinary L-FABP,serum creatinine（Scr）,glomerular filtration rate,fasting plasma glucose and insulin were measured by ELISA and biochemical methods respectively.Results：The level of urinary L-FABP in high urinary albumin excretion rate group was elevated significantly than that in low group（P0.01）,and it was closely related to blood lipid metabolism and insulin resistance.The AUC of urinary L-FABP for predicting progression of diabetic nephropathy was 0.85 with 85.5 % of sensitivity and 87.4% of specificity at the cut off L-FABP value of 33.2μg/（g·Cr）.Significant positive correlation between urinary L-FABP and eGFR（r=-0.641,P0.01）/serum creatinine（r=0.714,P0.01）were found.Conclusion：As a novel biomarkers,Urinary L-FABP can be used to diagnose diabetic nephropathy and predict its progression.