尿脂肪酸结合蛋白1与老年2型糖尿病患者肾功能快速下降的相关性

    Association of urinary fatty acid-binding protein 1 with a rapid decline of renal function in elders with type 2 diabetes mellitus

      摘要
    • 摘要:
      目的  探讨尿脂肪酸结合蛋白1（urinary fatty acid-binding protein 1，u-FABP1）与老年2型糖尿病（diabetes mellitus type 2，T2DM）患者肾功能快速下降的相关性。
      方法  本研究为前瞻性观察性研究，纳入2017年1月至12月在西安市第一医院内分泌门诊就诊的430例T2DM且保留肾功能的老年患者，至少随访5年，进行一系列估算肾小球滤过率（estimating the glomerular filtration rate，eGFR）测量。肾功能快速下降定义为年度eGFR下降值＞3 mL·min−1·（1.73m2）−1。研究基线血清u-FABP1水平与年度eGFR下降率之间的关系。
      结果  在5年的随访中，70例患者（16.28%）肾功能迅速下降。与非快速下降组患者相比，肾功能快速下降组患者基线u-FABP1水平用尿肌酐（urine creatinine，uCr）校正明显更高27.29（21.20，34.03）μg/g uCr比39.61（34.06，50.00）μg/g uCr，Z = −12.240，P＜0.001。调整年龄、性别、体重指数、糖化血红蛋白和基线eGFR等临床风险因素后，年度eGFR下降率与基线u-FABP1呈负相关（rs = −0.150，P = 0.005）。此外，经单因素和多因素Logistic回归分析，年龄＞75岁和基线u-FABP1水平≥16.76 μg/g uCr是肾功能快速下降的独立预测因子（P＜0.05）。当基线u-FABP1水平≥22.45 μg/g uCr时可良好的预测老年T2DM患者随访5年内肾功能快速下降的风险，受试者工作特征曲线下面积为0.962（95%CI：0.943～0.981），特异度和灵敏度分别为97.10%和77.70%。
      结论  较高的基线u-FABP1水平与肾功能保留的老年T2DM患者肾功能快速下降高风险有关，表明u-FABP1可能在早期糖尿病肾脏疾病的进展中发挥作用。

       

      Abstract:
      Objective  To explore the relationship between urinary fatty acid binding protein-1 （u-FABP1） and a rapid decline of renal function in elders with type 2 diabetes mellitus （T2DM）.
      Methods  From January to December 2017, 430 T2DM elders with preserved renal function were recruited for this prospective observational study. During a follow-up period of at least 5 years, they underwent a serial detection of estimated glomerular filtration rate （eGFR）. Rapid decline in renal function was defined as an annual decline of eGFR＞3 mL·min−1·（1.73m2）−1. The relationship between baseline serum level of u-FABP1 and an annual decline rate of eGFR was examined.
      Results  During 5-year follow-ups, 70 patients （16.28%） had a rapid decline in renal function. As compared with non-rapid decline group, baseline u-FABP1 level corrected with urinary creatinine （uCr） of patients was significantly higher in rapid decline group 27.29（21.20, 34.03） μg/g uCr vs 39.61 （34.06, 50.0） μg/g uCr, Z = −12.240, P＜0.001. After adjusting for such risk factors as age, gender, body mass index （BMI）, glycated hemoglobin A1c （HbA1c） and baseline eGFR, annual eGFR decline rate （%） was correlated negatively with baseline u-FABP1 （rs = −0.150, P = 0.005）. Futhermore, univariate and multivariate Logistic regression analyses indicated that age＞75 year and baseline u-FABP1≥16.76 ng/mg uCr were independent predictors of a rapid decline of renal function （P＜0.05）. When baseline level of u-FABP1 was≥22.45 ng/mg uCr, it could well predict the risk of a rapid decline of renal function. Area under receiver operating characteristic curve was 0.962 （95%CI: 0.943-0.981） with a specificity of 97.10% and a sensitivity of 77.70%.
      Conclusions  In T2DM elders with preserved renal function, elevated baseline level of u-FABP1 is associated with a high risk of rapid decline of renal function. It hints that u-FABP may play a role in the progression of early diabetic kidney disease.

       

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