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研究生:張藝馨
研究生(外文):Yi-Sin Chang
論文名稱: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
論文名稱(外文):The associations of liver type fatty acid binding protein with oxidative stress and renal function in patients with chronic kidney disease
指導教授:黃怡嘉黃怡嘉引用關係
指導教授(外文):Yi-Chia Huang
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:營養學系碩士班
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:58
中文關鍵詞: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
外文關鍵詞:chronic kidney diseaseliver type fatty acid binding proteinoxidative stressantioxidant capacityrenal function
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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。
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.
目錄
壹、 摘要……………………………………………………………………1
中文摘要………………………………………………………………1
英文摘要………………………………………………………………2
貳、 縮寫名稱………………………………………………………………4
參、 文獻回顧………………………………………………………………5
一、 腎臟簡介………………………………………………………..5
二、 慢性腎臟病……………………………………………………..8
三、 慢性腎臟病與氧化壓力………………………………………10
四、 肝臟型脂肪酸結合蛋白………………………………………13
五、 肝臟型脂肪酸結合蛋白與腎功能……………………………15
肆、 研究動機……………………………………………………………..17
伍、 研究目的及假說……………………………………………………..18
陸、 材料方法……………………………………………………………..19
一、 研究設計………………………………………………………19
二、 研究對象………………………………………………………20
三、 研究方法………………………………………………………21
四、 實驗室生化分析………………………………………………24
五、 統計方法………………………………………………………29
柒、 結果………………………………………………………………….30
捌、 討論………………………………………………………………….36
玖、 研究限制…………………………………………………………….39
壹拾、 結論…………………………………………...…………..… ……..40
表1~表6…………………………………………………………41
壹拾壹、 參考文獻……………………………………………………...48
附錄一……………………………………………………………………...57
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