目的    探讨α-klotho蛋白与肥胖相关肾小球病（ORG）的关系。 方法    选择我院2011年至2013年经肾穿刺病理检查明确的ORG患者25例、无ORG的慢性肾脏病（CKD）患者25例，单纯腹型肥胖者25例和健康对照25例，分别收集血和尿标本。通过倾向性评分对四组人的年龄、性别，单纯腹型肥胖和ORG患者的腹围，以及ORG和CKD患者的24 h尿蛋白定量进行配对，ELISA法检测α-klotho蛋白。正常对照组小鼠与ORG模型小鼠处死后取肾皮质，采用实时荧光定量PCR法检测mRNA表达，采用免疫印迹杂交法检测蛋白质表达。 结果 （1）血清α-klotho蛋白水平ORG组[（251.7±124.1） ng/L]、CKD组[（336.3±126.1） ng/L]和单纯腹型肥胖组[（377.1±120.4） ng/L]均低于健康对照组[（472.3±204.2） ng/L，均P＜0.05]，且ORG组低于单纯腹型肥胖组和CKD组（均P＜0.05）。（2）尿液-klotho蛋白水平ORG组[（24.7±11.4） mg/mol]明显低于健康对照组[（100.8±51.1） mg/mol]、单纯腹型肥胖组[（74.5±32.5） mg/mol]和CKD组[（82.5±33.8） mg/mol，均P＜0.05]，但健康对照组、单纯腹型肥胖组和CKD组之间无明显差异（均P＞0.05）。（3）与正常对照组相比较，ORG模型组小鼠肾组织中α-klotho的mRNA和蛋白水平均明显降低（均P＜0.05）。 结论    ORG患者血和尿中α-klotho蛋白均明显低于单纯腹型肥胖者，提示α-klotho可能是拮抗肥胖肾损伤的一个因子。

Objective    To investigate the relationship of α-klotho protein and obesity related glomerulonephritis.    Methods    The chronic kidney disease (CKD) patients with or without ORG were diagnosed by renal biopsy. The normal and abdominal obesity control people were enrolled from the physical examination center. Propensity scoring analysis was done to balance the four groups of people in important clinical characteristics. The α-klotho levels in blood and urine were detected by ELISA. ORG mouse model was established and the mRNA and protein expression of klotho protein were detected by real-time quantitative PCR and Western blotting.    Results    (1) The plasma α-klotho levels decreased in ORG patients, CKD patients and abdominal obesity control people compared with normal control people [(251.7±124.1) ng/L, (336.3±126.1) ng/L, (377.1±120.4) ng/L vs (472.3±204.2) ng/L, all P＜0.05]. The ORG patients had the lowest plasma α-klotho levels (P＜0.05). (2) ORG patients also had the lowest urine α-klotho levels compared with CKD patients, abdominal obesity and normal control people [(24.7±11.4) mg/mol vs (82.5±33.8) mg/mol, (74.5±32.5) mg/mol, (100.8±51.1) mg/mol, all P＜0.05]. There was no difference in urine α-klotho levels of CKD patients, abdominal obesity and normal control people. (3) Compared with the normal control mouse, ORG model mouse showed decreased mRNA and protein expression of α-klotho protein in renal tissue.    Conclusion    The lower plasma and urine α-klotho levels in ORG patients may be due to the reduced expression of α-klotho protein in kidney.