Kamijo Atsuko, Kimura Kenjiro, Sugaya Takeshi, Yamanouchi Masaya, Hikawa Akihisa, Hirano Norihito, Hirata Yasunobu, Goto Atsuo, Omata Masao
Second Department of Internal Medicine, University of Tokyo, Tokyo, Japan.
J Lab Clin Med. 2004 Jan;143(1):23-30. doi: 10.1016/j.lab.2003.08.001.
Previous studies have indicated that in massive proteinuria, free fatty acids (FFAs) bound to albumin were overloaded in the proximal tubule and exacerbated tubulointerstitial damage. Liver-type fatty acid-binding protein (L-FABP) is an intracellular carrier protein of FFAs that is expressed in the proximal tubule of human kidney. We sought to evaluate urinary L-FABP as a clinical marker in chronic renal disease. Urinary L-FABP was measured in patients with nondiabetic chronic renal disease (n = 120) with the use of a newly established ELISA method. We then monitored these patients for 15 to 51 months. Clinical data were analyzed with multivariate analysis. Urinary L-FABP was correlated with urinary protein, urinary alpha(1)-microglobulin, and serum creatinine concentrations. Urinary L-FABP at the start of follow-up (F = 17.1, r =.36, P <.0001) was selected as a significant clinical factor correlated with the progression rate, defined as a slope of a reciprocal of serum creatinine over time. We next selected the patients with mild renal dysfunction (n = 35) from all 120 patients and divided them into 2 groups according to progression rate: the progression group (n = 22) and the nonprogression group (n = 13). Serum creatinine and urinary protein concentrations and blood pressure at the start of follow-up were higher in the progression group than in the nonprogression group, although we detected no significant difference between the 2 groups. Urinary L-FABP was significantly higher in the former group than in the latter (P <.05). The results showed that urinary L-FABP reflected the clinical prognosis of chronic renal disease. Urinary L-FABP may be a clinical marker that can help predict the progression of chronic glomerular disease.
以往研究表明，在大量蛋白尿时，与白蛋白结合的游离脂肪酸（FFA）在近端小管中过载，加剧了肾小管间质损伤。肝型脂肪酸结合蛋白（L-FABP）是FFA的一种细胞内载体蛋白，在人肾近端小管中表达。我们试图评估尿L-FABP作为慢性肾病的一种临床标志物。采用新建立的酶联免疫吸附测定（ELISA）方法，对120例非糖尿病慢性肾病患者的尿L-FABP进行了检测。然后对这些患者进行了15至51个月的监测。采用多变量分析对临床数据进行分析。尿L-FABP与尿蛋白、尿α1-微球蛋白及血清肌酐浓度相关。随访开始时的尿L-FABP（F = 17.1，r =.36，P <.0001）被选为与进展率相关的一个重要临床因素，进展率定义为血清肌酐倒数随时间变化的斜率。接下来，我们从全部120例患者中选取轻度肾功能不全患者35例，根据进展率将其分为2组：进展组（n = 22）和非进展组（n = 13）。随访开始时，进展组的血清肌酐、尿蛋白浓度及血压均高于非进展组，尽管两组之间未检测到显著差异。进展组的尿L-FABP显著高于非进展组（P <.05）。结果表明，尿L-FABP反映了慢性肾病的临床预后。尿L-FABP可能是一种有助于预测慢性肾小球疾病进展的临床标志物。
