慢性腎臟病患者的肝臟型脂肪酸結合蛋白濃度與氧化壓力及腎功能之相關性

慢性腎臟病患者常因為尿毒素的產生、抗氧化能力的降低或共病因子，造成患者體內的氧化壓力升高而加速病程進展。肝臟型脂肪酸結合蛋白雖然主要存在肝臟中但也存在於腎臟，通常由尿液排出體外，因具有高度結合脂肪酸過氧化產物的能力，被認為可以擔任人體內的內生性抗氧化物質，以及可做為腎臟疾病預測或預後的指標值。目前研究多著重在測量尿液肝臟型脂肪酸結合蛋白濃度以評估腎臟病患的病程及氧化壓力狀況，但血漿肝臟型脂肪酸結合蛋白濃度與患者的氧化壓力狀況及腎功能的相關性尚未被深入探討。因此，本研究目的是比較第一期至第四期慢性腎臟病患者血漿及尿液肝臟型脂肪酸結合蛋白濃度、氧化壓力指標以及抗氧化能力之差異；並探討血漿及尿液肝臟型脂肪酸結合蛋白與氧化壓力、抗氧化能力及腎功能指標之相關性。本研究是以醫院為基礎的橫斷面研究，於臺中榮民總醫院腎臟科門診進行，共招募185位慢性腎臟病第一期至第四期患者。結果顯示第一至四期的患者血漿氧化壓力指標（丙二醛、氧化型低密度脂蛋白）及血漿抗氧化能力指標（總抗氧化能力、肝臟型脂肪酸結合蛋白、穀胱甘肽過氧化酶）濃度皆無顯著差異。尿液肝臟型脂肪酸結合蛋白濃度在慢性腎臟病第二期顯著高於第一期及第三期患者。以 Partial Pearson correlation 調整年齡、性別、身體質量指數、收縮壓、有無糖尿病、抽菸及喝酒習慣，血漿及尿液肝臟型脂肪酸結合蛋白與氧化壓力、抗氧化能力及腎功能指標皆無顯著相關性。血漿及尿液肝臟型脂肪酸結合蛋白濃度可能皆無法反映第一至第四期慢性腎臟病患者的氧化壓力、抗氧化能力以及腎功能的狀況。

關鍵字

慢性腎臟病；肝臟型脂肪酸結合蛋白；氧化壓力；抗氧化能力；腎功能

並列摘要

Uremic toxins, decreased antioxidant capacities or comorbidity may increase oxidative stress and further accelerate the disease progression in patients with chronic kidney disease (CKD). Liver type fatty acid binding protein (L-FABP) is expressed not only in the liver but also in the kidney, and is usually excreted in urine. Liver type fatty acid binding protein has a high affinity and capacity to bind the production of fatty acid peroxidation, it is thus considered to be an endogenous antioxidant and be a clinical biomarker for predicting the progression or prognosis of CKD. Recent studies were mainly focusing on the association of urinary L-FABP with the renal function and oxidative stress in patients with CKD. However, the associations of plasma L-FABP with renal function and oxidative stress have not been further examined yet. Therefore, the purpose of our study was to compare the differences among plasma and urinary L-FABP concentrations, oxidative stress and antioxidant capacities in patients with stage 1 - 4 CKD, and additionally evaluated the associations of plasma and urinary L-FABP with oxidative stress, antioxidant capacities and renal function. This research is a cross-sectional study and recruited 185 stage 1 - 4 CKD patients from the nephrology outpatient clinics of the Taichung Veterans General Hospital, Taichung. Results showed that there were no significantly differences in plasma oxidative stress markers (malondialdehyde and oxidized low-density lipoprotein), and antioxidant capacity markers (total equivalent antioxidant capacity, L-FABP and glutathione peroxidase) among different stage of CKD. However, urinary L-FABP levels in patients with stage 2 CKD were significantly higher than patients in stage 1 and stage 3 CKD. Partial Pearson correlation analysis indicated that plasma and urinary L-FABP were not associated with indicators of oxidative stress, antioxidant capacities and renal function after adjusting for age, sex, body mass index, systolic blood pressure, diabetes mellitus, smoking and drinking habits. In conclusion, plasma and urinary L-FABP may not reflect oxidative stress, antioxidant capacities and renal function in patients with stage 1 - 4 CKD.

並列關鍵字

chronic kidney disease ； liver type fatty acid binding protein ； oxidative stress ； antioxidant capacity ； renal function

參考文獻

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慢性腎臟病患者的肝臟型脂肪酸結合蛋白濃度與氧化壓力及腎功能之相關性

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