血清miR-141水平与糖尿病肾病患者肾脏损伤及远期预后的关系

摘要

Objective To investigate the relationship between serum miR-141 level and renal injury and long-term prognosis in diabet-ic nephropathy (DN)patients. Methods From January 2012 to December 2015,114 serum samples of DN patients and 119 healthy subjects (control)were collected and detected by real-time quantitative PCR. The relationship between serum miR-141 level and common clinical indi-cators (gender,age,BMI,duration of diabetes,urine protein quantity,blood calcium,fasting blood glucose,HbA1c and eGFR)were analyzed. The glomerular grading,interstitial fibrosis,tubular atrophy score (IFTA)and interstitial inflammation of kidney damage were used to evaluate the degree of renal damage. The miR-141 levels in different kidney injuries were analyzed and the relationship between miR-141 levels and progno-sis was analyzed according to the median value of miR-141 level. Results QPCR detection showed that the serum miR-141 level of patients with DN was (6. 312 ± 1. 804)(median value of 5. 816),higher than that of healthy controls (1. 247 ± 0. 219),and the difference was statisti-cally significant (P < 0. 05). Serum miR-141 levels in DN patients did not related to sex,age and serum calcium,but were related to BMI,du-ration of diabetes,proteinuria,fasting plasma glucose,HbA1c and eGFR (P < 0. 05). The level of serum miR-141 in patients with DN was re-lated to glomerular grading,IFTA and interstitial inflammation,and the level of serum miR-141 and high expression rate increased (P < 0. 05) as the degree of renal pathological damage increased. Spearman correlation analysis showed that serum miR-141 levels were positively correlated with glomerular grading,IFTA and interstitial inflammation in patients with DN,and the correlation coefficients were 0. 329,0. 226 and 0. 426 ( P = 0. 000,0. 015 and 0. 000),respectively. Among 114 cases of DN patients,42 cases of end-stage renal disease occurred during the follow- up period (ESRD),the serum level of miR-141 was (7. 153 ± 2. 018),which was higher than 72 cases without ESRD (5. 821 ± 1. 775)and the differences were statistically significant (P < 0. 05). Compared the low level of miR-141 group,the high level of miR-141 group had an increased risk of 6. 333 folds. Conclusion The elevation of serum miR-141 levels in patients with DN related with DN renal injury and progno-sis. The patients with higher miR-141 level presented a more serious renal injury and poor prognosis,and had a certain value in the evaluation of DN disease prediction and prognosis.%目的 探讨血清miR-141水平与糖尿病肾病(DN)患者肾脏损伤及远期预后的关系.方法 收集2012年1月至2015年12月的114例DN患者及119例健康体检者(对照组)的血清标本并采用实时定量PCR检测miR-141水平,分析血清miR-141水平与常见临床指标(性别、年龄、BMI、糖尿病病程、蛋白尿定量、血钙、空腹血糖、HbA1c及eGFR)的关系,采用肾小球分级、间质性纤维化和小管萎缩评分(IFTA)及间质炎症来评价肾脏损伤情况,并分析不同肾脏损伤程度的miR-141水平,根据miR-141水平的中位值分组后分析miR-141水平与预后的关系.结果 qPCR检测发现DN患者的血清miR-141水平为(6.312±1.804)(中位值为5.816),高于健康对照组的(1.247±0.219),差异有统计学意义(P<0.05).DN患者的血清miR-141水平与性别、年龄和血钙无关,但与BMI、糖尿病病程、蛋白尿定量、空腹血糖、HbA1c及eGFR有关(P<0.05);DN患者的血清miR-141水平与肾小球分级、IFTA及间质炎症均有关,且随着肾脏病理损伤程度的增加,血清miR-141水平和高表达率均升高(P<0.05).经Spearman相关分析发现,DN患者的血清miR-141水平与肾小球分级、IFTA和间质炎症均呈正相关,相关系数依次为0.329、0.226和0.426(P<0.05).114例DN患者有42例在随访期间进入终末期肾病(ESRD),其血清miR-141水平为(7.153±2.018),高于72例未进入ESRD的(5.821±1.775),差异均有统计学意义(P<0.05),且miR-141高水平组相对于低水平进入ESRD的风险升高6.333倍.结论 DN患者的血清miR-141水平升高,且其水平与DN患者肾脏损伤及预后有关,miR-141较高者的肾脏损伤程度较严重且预后较差,在DN病情预测及预后评估上有一定价值.