对比剂肾病中肝型脂肪酸结合蛋白的尿排泄情况

Urinary excretion of liver-type fatty acid-binding protein in contrast medium-induced nephropathy.

作者信息

Nakamura Tsukasa, Sugaya Takeshi, Node Koichi, Ueda Yoshihiko, Koide Hikaru

机构信息

Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.

出版信息

Am J Kidney Dis. 2006 Mar;47(3):439-44. doi: 10.1053/j.ajkd.2005.11.006.

DOI:10.1053/j.ajkd.2005.11.006

PMID:16490622

Abstract

BACKGROUND

Administration of contrast agents can cause a decrease in renal function and, occasionally, end-stage renal disease. Liver-type fatty acid-binding protein (L-FABP) is an intracellular carrier protein of free fatty acids that is expressed in proximal tubules of the human kidney. Whether urinary excretion of L-FABP can predict the occurrence of contrast medium-induced nephropathy was studied.

METHODS

Sixty-six patients (46 men, 20 women; mean age, 60.0 years) undergoing nonemergency coronary angiography or intervention at 1 of our institutions who had a serum creatinine (Cr) level greater than 1.2 mg/dL (> 106 micromol/L) and less than 2.5 mg/dL (< 221 micromol/L) and 30 healthy volunteers (21 men, 9 women; mean age, 56.5 years) were included. Urinary L-FABP levels were measured before and after coronary angiography with the use of monoclonal antibodies. Contrast medium-induced nephropathy is defined as an increase in serum Cr level of greater than 0.5 mg/dL (> 44 micromol/L) or a relative increase of more than 25% at 2 to 5 days after the procedure.

RESULTS

Contrast medium-induced nephropathy occurred in 13 of 66 patients (19.7%). Before angiography, urinary L-FABP levels were significantly greater in these 13 patients (contrast medium-induced nephropathy group; 18.5 +/- 12.8 microg/g Cr; range, 5.8 to 33.6 microg/g Cr) than in the remaining 53 patients (non-contrast medium-induced nephropathy group; 7.4 +/- 4.4 microg/g Cr; range, 2.8 to 13.8 microg/g Cr; P < 0.01) or healthy volunteers (5.4 +/- 4.4 microg/g Cr; range, 1.0 to 10.0 microg/g Cr; P < 0.01). The next day and 2 days after angiography, urinary L-FABP levels increased significantly to 46.8 +/- 30.5 microg/g Cr (range, 12.0 to 84.5 microg/g Cr; P < 0.01) and 38.5 +/- 28.5 microg/g Cr (range, 9.5 to 70.5 microg/g Cr; P < 0.01) in the contrast medium-induced nephropathy group, respectively. After 14 days, serum Cr returned to the baseline level, but urinary L-FABP level remained high (34.5 +/- 30.0 microg/g Cr; range, 4.0 to 68.0 microg/g Cr). However, urinary L-FABP levels in the non-contrast medium-induced nephropathy group changed little throughout the experimental period.

CONCLUSION

Urinary L-FABP level can serve clinically as a predictive marker for contrast medium-induced nephropathy.

摘要

背景

使用造影剂可导致肾功能下降，偶尔还会引发终末期肾病。肝型脂肪酸结合蛋白（L-FABP）是一种游离脂肪酸的细胞内载体蛋白，在人肾近端小管中表达。本研究旨在探讨L-FABP的尿排泄量能否预测造影剂肾病的发生。

方法

选取66例（46例男性，20例女性；平均年龄60.0岁）在我院接受非急诊冠状动脉造影或介入治疗的患者，其血清肌酐（Cr）水平大于1.2mg/dL（>106μmol/L）且小于2.5mg/dL（<221μmol/L），同时纳入30名健康志愿者（21例男性，9例女性；平均年龄56.5岁）。使用单克隆抗体在冠状动脉造影前后测量尿L-FABP水平。造影剂肾病定义为术后2至5天血清Cr水平升高大于0.5mg/dL（>44μmol/L）或相对升高超过25%。

结果

66例患者中有13例（19.7%）发生造影剂肾病。在造影前，这13例患者（造影剂肾病组；18.5±12.8μg/g Cr；范围5.8至33.6μg/g Cr）的尿L-FABP水平显著高于其余53例患者（非造影剂肾病组；7.4±4.4μg/g Cr；范围2.8至13.8μg/g Cr；P<0.01）或健康志愿者（5.4±4.4μg/g Cr；范围1.0至10.0μg/g Cr；P<0.01）。在造影后第2天和第2天，造影剂肾病组的尿L-FABP水平分别显著升高至46.8±30.5μg/g Cr（范围12.0至84.5μg/g Cr；P<0.01）和38.5±28.5μg/g Cr（范围9.5至70.5μg/g Cr；P<0.01）。14天后，血清Cr恢复至基线水平，但尿L-FABP水平仍保持较高（34.5±30.0μg/g Cr；范围4.0至68.0μg/g Cr）。然而，在整个实验期间，非造影剂肾病组的尿L-FABP水平变化不大。