嗜中性白血球明膠相關性脂質運載蛋白及尿調理素與慢性腎臟疾病的相關性，已經吸引很多人投入研究，並且結果顯示尿調理素在慢性腎臟疾病進展中扮演積極的角色。本研究經由腎臟科和風濕病科門診，針對77位疾病穩定患者，收集了他們的基本資料及實驗室數值，包括尿液尿白蛋白排泄、血清肌酸酐、血清尿酸、腎絲球過濾率、尿肌酸酐、嗜中性白血球明膠相關性脂質運載蛋白及尿調理素。結果顯示，尿液嗜中性白血球明膠相關性脂質運載蛋白的排出量與腎絲球過濾率產生負性關聯；尿液尿調理素的排出量與腎絲球過濾率正相關。性別和尿液嗜中性白血球明膠相關性脂質運載蛋白的排出量與慢性腎臟疾病沒有明顯關聯；然而，慢性腎臟疾病組及非慢性腎臟疾病組在年齡和血清尿酸有顯著的差異，使用多變異性分析顯示慢性腎臟疾病的病人有比較低的尿液尿調理素排出量，通常是比較年老者；尿液嗜中性白血球明膠相關性脂質運載蛋白排出量、尿液白蛋白排出量、糖尿病狀態、高血壓、痛風跟慢性腎臟疾病沒有相關。我們的研究顯示尿調理素(UMOD)可能在慢性腎臟疾病扮演一個角色，而與尿液嗜中性白血球明膠相關性脂質運載蛋白(UNGAL)較無相關，未來可以進一步的研究關於慢性腎臟疾病的動物模型，建立基本的病例機制，並探討其臨床意義。

The link between neutrophil gelatinase-associated lipocalin ( NGAL) and uromodulin (UMOD) with chronic kidney disease (CKD) has attracted much interest in the medical literature. Several investigations showed UMOD had active role in CKD progression. A total of 77 Taiwanese patients with stable disease activity selected from the cohort that attended our renal and rheumatology outpatient department were enrolled. Their demographic data, laboratory tests including urinary microalbumiuria excretion, serum creatinine, serum uric acid, eGFR, and urinary creatinine, NGAL and UMOD level were measured. The results showed that urinary NGAL excretion correlated negatively with eGFR, and urinary UMOD excretion correlated positively with eGFR. Gender and urinary NGAL excretion did not differ between the CKD and non-CKD groups. However, age (CKD group: 64.5± 12.13 years, Non-CKD group: 47.03±11.87 years, p< 0.0001) and serum uric acid (CKD group: 8.12 ± 2.32 mg/dl, Non-CKD group: 6.39 ± 1.72 mg/dl, p<0.001) were significantly different between groups. Using multivariate analysis, patients with CKD had lower urinary UMOD excretion (Odds Ratio 0.82, 95% confidence interval: 0.69-0.98, p=0.029), and were more likely to be older (p< 0.01). Urinary NGAL excretion, urinary albumin excretion, status of diabetic mellitus, hypertension, gout were not associated with status of CKD. Our study indicated that UMOD might play a role in the development of CKD. Urinary NGAL excretion was not associated with gout or CKD. Further studies with animal model of gout and CKD are mandatory to establish fundamental pathological mechanism and explore the clinical implications

目錄
論文審定書 i
誌謝 ii
目錄 iii
中文摘要 v
英文摘要 vi
縮寫表 vii
前言 1
研究目標 14
材料和研究方法 15
結果 19
討論 21
未來研究與展望 24
參考文獻 25
表1:慢性腎臟病和非慢性腎臟病病人各變項間的比較 27
表2:尿液嗜中性白血球明膠相關性脂質運載蛋白的排出量與腎絲球過濾率的相關性 28
表3:尿調理素排出量與腎絲球過濾率的相關性 29
表4:以逐步邏輯迴歸選取法來分析病人各個變量和慢性腎臟病的關係 30
表5: 非痛風和痛風病人各變項間的比較 31
附錄:人體試驗倫理委員會研究計畫證明書 32

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