CAJ | 학술논문

目的：通过检测原发性肾病综合征（PNS）患者血清、尿肝型脂肪酸结合蛋白（L-FABP）的水平，观察肾组织L-FABP表达，研究其与病理类型的关系及在PNS合并急性肾损伤（ AKI）时的变化和意义。方法45例PNS患者根据病理结果是否有急性肾小管坏死（ ATN）分为：不伴有ATN的PNS未合并AKI组（ PNS未合并AKI组）37例，其中系膜增生性肾炎（MsPGN）13例、轻微病变（MCD）5例、局灶节段性肾小球硬化（FSGS）9例、膜性肾病（MN）10例；伴有ATN的PNS合并AKI组（PNS合并AKI组）8例，病理类型均为MCD。另取10例健康体检者的血清、尿及10例因肾肿瘤行肾切除术但远离肿瘤部的正常肾组织作为对照组。酶联免疫吸附试验（ ELISA ）检测血清、尿中L-FABP水平，免疫组化法测定肾组织中L-FABP表达量。结果①PNS未合并AKI组各病理类型患者血清、尿L-FABP水平及肾组织L-FABP表达均高于对照组（ P＜0．05），其中FSGS患者尿L-FABP水平及肾组织L-FABP表达高于其他病理类型（P＜0．05），血清L-FABP水平在各病理类型间差异无统计学意义（ P＞0．05）。②PNS合并AKI组血清、尿L-FABP水平及肾组织L-FABP表达较PNS未合并AKI组升高（ P＜0．05）。③血清、尿L-FABP及血肌酐（SCr）诊断AKI的ROC曲线下面积（AUC）分别为0．910、0．973、0．812。④血清、尿L-FABP水平分别与SCr、血尿素氮（BUN）、24 h尿蛋白定量（24hUpro）、肾组织L-FABP表达呈正相关（r＝0．331～0．764，P＜0．05），分别与血白蛋白（ALB）、尿渗透压（OSM）呈负相关（r＝-0．665～-0．482，P＜0．05）。结论 L-FABP可作为早期诊断PNS合并AKI的敏感指标。
목적：통과검측원발성신병종합정（PNS）환자혈청、뇨간형지방산결합단백（L-FABP）적수평，관찰신조직L-FABP표체，연구기여병리류형적관계급재PNS합병급성신손상（ AKI）시적변화화의의。방법45례PNS환자근거병리결과시부유급성신소관배사（ ATN）분위：불반유ATN적PNS미합병AKI조（ PNS미합병AKI조）37례，기중계막증생성신염（MsPGN）13례、경미병변（MCD）5례、국조절단성신소구경화（FSGS）9례、막성신병（MN）10례；반유ATN적PNS합병AKI조（PNS합병AKI조）8례，병리류형균위MCD。령취10례건강체검자적혈청、뇨급10례인신종류행신절제술단원리종류부적정상신조직작위대조조。매련면역흡부시험（ ELISA ）검측혈청、뇨중L-FABP수평，면역조화법측정신조직중L-FABP표체량。결과①PNS미합병AKI조각병리류형환자혈청、뇨L-FABP수평급신조직L-FABP표체균고우대조조（ P＜0．05），기중FSGS환자뇨L-FABP수평급신조직L-FABP표체고우기타병리류형（P＜0．05），혈청L-FABP수평재각병리류형간차이무통계학의의（ P＞0．05）。②PNS합병AKI조혈청、뇨L-FABP수평급신조직L-FABP표체교PNS미합병AKI조승고（ P＜0．05）。③혈청、뇨L-FABP급혈기항（SCr）진단AKI적ROC곡선하면적（AUC）분별위0．910、0．973、0．812。④혈청、뇨L-FABP수평분별여SCr、혈뇨소담（BUN）、24 h뇨단백정량（24hUpro）、신조직L-FABP표체정정상관（r＝0．331～0．764，P＜0．05），분별여혈백단백（ALB）、뇨삼투압（OSM）정부상관（r＝-0．665～-0．482，P＜0．05）。결론 L-FABP가작위조기진단PNS합병AKI적민감지표。
Objective By detecting liver-type fatty acid binding protein (L-FABP) levels in serum, urine and L-FABP expression in renal tissues in patients with primary nephrotic syndrome ( PNS), to investigate its relationship with pathological type and PNS with acute kidney injury (AKI).Methods 45 patients with PNS were divided into 2 groups according to whether they had acute tubular necrosis ( ATN) .There were 37 cases of PNS without ATN and AKI ( PNS without AKI group ) .According to the pathological types , they were further divided into mesangial proliferative glomerolonephritis (MsPGN) group (13 cases), minimal change disease (MCD) group (5 cases), focal segmental glo-merulosclerosis (FSGS) group (9 cases), and membranous nephropathy (MN) group (10 cases).There were 8 cases of PNS with ATN and AKI (PNS with AKI group ) , in which all cases were MCD .Serum and urine of 10 healthy subject who received routine physical checkup and 10 normal renal tissues located far from renal tumor in patients with nephritic tumor served as control groups .The levels of L-FABP in serum and urine were detected by enzyme -linked immunosor-bent assay ( ELISA) .Immunohistochemical staining was used to detect the expression of L -FABP in renal tissues .Re-sults ①The levels of L-FABP in serum and urine and expression of L -FABP in renal tissues in patients with PNS were significantly higher than those of the control group (P<0.05).Compared with the MsPGN group, MCD group and MN group, the urine L-FABP and renal L-FABP in the FSGS group increased significantly (P<0.05).However, there were no significant difference in serum among the 4 pathological types (P>0.05).②The serum and urine levels of L-FABP and the expression of L -FABP in renal tissures were enhanced in the PNS with AKI group compared with the PNS without AKI group (P<0.05).③The receiver operator characteristic curve′s area under the curve (ROC-AUC) of serum, urine L-FABP and serum creatinine (SCr) for diagnosis of AKI were 0.910, 0.973, 0.812, respectively.④The serum and urine levels of L -FABP were positively correlated with SCr , blood urea nitrogen (BUN), 24 h urine pro-tein (24hUpro) and expression of L -FABP in renal tissures (r=0.331~0.764, P<0.05), and were negatively cor-related with albumin (ALB) and urine osmotic pressure (OSM) (r=-0.665~-0.482, P<0.05).Conclusion L-FABP can be used as a sensitive biomarker for the diagnosis of AKI at early time in patients with PNS .