尿肝型脂肪酸结合蛋白预测慢性肾小球肾炎进展的价值

目的 评估尿肝型脂肪酸结合蛋白(L-FABP)预测慢性肾小球肾炎(CGN)病情进展的临床价值.方法 前瞻性入选2004年1月至2005年12月期间在我院行肾穿刺活检明确病理诊断的原发性CGN患者123例为对象,另选28例年龄、性别匹配的健康志愿者为对照.用酶联免疫吸附法检测肾穿刺前新鲜尿液L-FABP含量,同时常规检测各项血液及尿液指标.对所有患者进行5年随访,每3个月随访1次,在随访结束时分为疾病进展组和非进展组,评估影响CGN进展的危险因素.结果 与对照组相比,CGN患者尿L-FABP均值明显升高(P＜0.01).尿L-FABP与估计肾小球滤过率(eGFR)呈负相关(r=-0.565,P＜0.01)；与尿蛋白量(r=0.501,P＜0.01)和Scr(r=0.601,P＜0.01)呈正相关.Kaplan-Meier分析显示,尿L-FABP＞76.58 μg/g·cr的CGN患者的预后显著变差.尿L-FABP预测CGN进展的ROC曲线下面积(AUC)为0.95.尿L-FABP为119.8 μg/g·cr时,其敏感性为87.5％,特异性为90.5％.结论 尿L-FABP可作为监测慢性肾小球肾炎疾病进展的新生物学标记物.

Value of urinary liver-type fatty acid binding protein in prediction of renal function progression in patients with chronic glomerulonephritis

Objective To evaluate the value of urinary liver-type fatty acid binding protein （L-FABP）as a biomarker in prediction of renal function progression in patients with chronic glomerulonephritis (CGN). Methods A total of 123 patients with newly diagnosed CGN by renal biopsy in Shanghai Renji Hospital between 2004 January and 2005 December were enrolled in the study. Twenty-eight healthy subjects were used as control group. Urine samples were collected before biopsy and treatment, and urinary L-FABP was measured by ELISA. The patients with follow-up every three months for 5 years were divided into progressive group and non-progressive group. The progression of kidney function impairment was defined as a reduction of GFR ≥ 5 ml•min-1•(1.73 m2)-1•year-1 during follow-up. The risk factors of progressive renal function were evaluated and the Spearman correlation analysis was performed to find out the prognostic indicator of renal function deterioration. Results Urinary L-FABP level of CGN patients was significantly higher than that of healthy control group (P<0.01). Urinary L-FABP in CGN patients was negatively correlated with eGFR (r=-0.565, P< 0.01) and positively correlated with proteinuria (r=0.501, P<0.01) and Scr (r=0.601, P<0.01). Kaplan-Meier analysis showed that urinary L-FABP excretion>76.58 μg/g•cr predicted progression of renal function. The AUC of urinary L-FABP for prognosis of CGN progression was 0.95, with 87.5% of sensitivity and 90.5% of specificity at the cutoff value of 119.8 μg/g•cr, which revealed its great value of predicting the prognosis of CGN patients. Conclusion Urinary L-FABP can be a novel biomarker of evaluation for renal injury and early progressive renal function deterioration in patients with CGN.