당뇨병환자에서 뇨중 Fibronection치에 관한 연구

Abstract

Objectives: In diabetic nephropathy, thickening of basement membrane in the glomerulus and tubule is a well-known finding. Therefore, we evaluated whether the excretion of urinary fibronectin, which is one of important factors of basement membrane, is related with the presence of diabetic nephropathy.

Methods: We measured and compared the urinary fibronectin excretion rate(FER) and the albumin excretion rate(AER) in 20 healthy controls and 89 diabetic patients; 44patients without microalbuminuria, 26 patients with microalbuminuria, 19 patients with overt nephropathy. Urinary fibronectin levels were measured by our enzyme linked immunosorbent assay(ELISA) method and urinary microaibumin by radioimmunoassay.

Results: Patients with overt proteinuria were characterized by a significantly(p<0.005) longer duration of diabetes(Mean±SD: 97.1 ±30.8 years, 60.5± 74.4 years, 62.2 ±58.3 years) and by a higher systolic presure( 134.2 ± 19.5mmHg, 120.5 ± 5.8 mmHg, 121.8 ± 14.2mmHg, 127.7 ± 14.5mmHg) compared with control and diabetic patients with or without microabluminuria 2) The mean fibronectin excretion rate was signif'icantly(p<0.05) higher in the group with microalbuminuria(277.9±244.6/ig/min) than in normoalbuminuria patients( 165.7 ±90.3//g/ min) or in control subjeets( 184.1 ±96.9/ig/min) and also significantly (p<0.005) higher in the group with overt proteinuria(370.6±331.6/ig/min) than in microalbuminuria(277.9 ±244.6//g/min) or in normoalbuminuria (165.7±90.3//g/min) 3) Significant(p <0.01, p<0.001) degree of correlation were found between urine fibronectin excretion rate and duration of diabetes(r =0.31) or systolic blood pressure(r =0.35), where as AER significnatly(p<0.01) correlated with duration of disease(r=0,27). 4) Urine fibronectin excretion rate were, significantly ocrre-lated with AER(r = 0.13, p<0.001)

Conclusion: The results of this study suggest that FER is a useful indicator for the occurrence and progression of early diabetic nephropathy.

Key Words: Diabetes, Nephropathy, Urinary fibronectin