栄養指標蛋白としてのトランスフェリン,トランスサイレチンおよびレチノール結合蛋白の測定意義

type:原著

type:Original

ベーリングネフェロメーターアナライザーII(BNII)を使用し,栄養指標蛋白としてのトランスフェリン(Tf),トランスサイレチン=プレアルブミン(TTR)およびレチノール結合蛋白(RBP)の測定について基礎的検討と臨床的有用性についての検討を行った.Tf,TTR,RBPの再現性は変動係数(CV)5.1%以下,直線性は良好であったが,共存物質において乳び(カイロミクロンによる濁り)血清による負の影響がRBPとTTRで約30%～40%認められた.開腹手術後のTf,TTR,RBPの推移は,術前の値を100%とした場合,TTRとRBPは術後3日目に約55%まで低下し,その後は上昇に転じ7日目で約70%,11日目では80%前後まで回復することが認められた.これに対し,総蛋白(TP)とアルブミン(Alb)は術後3日目で90%と81%,7日目は92%と80%,11日目は90%と83%であり変動を認めなかった.Tfの変動はTPとAlbよりも大きかったが,TTRとRBPよりも小さかった.今回の検討から栄養指標蛋白としては,TPやAlbに比べ半減期が短いTf,TTR,RBPの方が栄養状態を鋭敏に反映していることが明らかにされた.Tf,TTR,RBPを日常検査へ導入することで,患者の栄養管理について客観的な評価に有用であると考えられる.

We investigated the assay performance and clinical usefulness of transfferin (Tf), trans thyretin (TTR) and retinol-binding protein (RBP) as nutrition assessment proteins. Assay precision, linearity and nonspecific reactions were examined with Behring Nephelometer Analyzer II (BNII). The assay precision (Coefficient of variation : CV) was less than 5.1%. The linearity showed the good performance. But, lipemic sera showed 30% negative bias in measurement of TTR and RBP. In patients with abdominal surgery total protein (TP), albumin (Alb), Tf, TTR and RBP were measured for lldays after operation. When the assay results of TTR and RBP at the pre-operation time were taken as 100%, the assay results at the day 3 were decreased to 55%. The assay results at the day 7 and at the day 11 were increased to 70% and 80%, respectively for TTR and RBP. However, the assay results of TP and Alb at the day 3 were decreased to 90% and 81 %, respectively. The assay results at the day 7 were slightly increased to 92% and 80%. Furthermore, the assay results at the day 11 were increased to 90% and 83%. The changes of Tf were bigger than the changes of Alb and TP and smaller than the changes of TTR and RBP. The changes of Tf, TTR and RBP were bigger than the changes of TP and Alb due to the short half life and the small stock in the body. In conclusion, this study shows the monitering of patients' nutritional state was successfully achieved by measurement of Tf, TTR and RBP.

identifier:6

identifier:KJ00004161886