糖尿病肾病患者外周血微小RNA-21表达与肾间质损伤的关系及意义

目的:探讨外周血微小RNA-21(miR-21)表达水平与糖尿病肾病(DN)患者肾间质损伤的关系及意义。方法:选取145例糖尿病及DN患者为病理对象,根据发病程度分为中重度DN41例,轻度DN44例,单纯糖尿病60例;另以60例同期入院体检的健康志愿者为对照组;抽取空腹肘静脉血,采用荧光定量PCR实验测定miR-21mRNA表达水平;采用酶联免疫分析仪测定患者肾功能标志物血肌酐、尿氮素、尿酸及胱抑素水平,采用化学发光分析仪测定纤维化损伤标志物转化生长因子(TGF-β)、透明质酸(HA)、Ⅳ型胶原(CⅣ)及Ⅲ型前胶原(PCⅢ)水平。结果:轻度DN和中重度DN的miR-21mRNA表达水平高于对照组和单纯糖尿病,中重度DN组的miR-21mRNA表达水平高于轻度DN,差异有统计学意义(P<0.05)。单纯糖尿病、轻度DN和中重度DN的血肌酐、尿氮素、尿酸、胱抑素、TGF-β、HA、CⅣ及PCⅢ水平高于对照组,轻度DN和中重度DN高于单纯糖尿病,中重度DN高于轻度DN,差异有统计学意义(P<0.05)。Pearson检验结果显示,糖尿病肾病患者外周血miR-21mRNA表达水平与血肌酐、尿氮素、胱抑素、TGF-β、CⅣ、PCⅢ均呈直线正相关性(P<0.05)。ROC曲线分析结果显示miR-21mRNA表达对轻度DN和中重度DN均有预测价值(P<0.05)。结论:外周血miR-21表达水平与肾间质损伤程度密切相关,有望成为预测DN的发生与发展的重要参考指标。

Relationship and significance between blood miR-21 expression and renal interstitial injury in diabetic nephropathy

Objective: To explore the relationship and significance between miR-21 expression and renal interstitial injury in diabetic nephropathy(DN). Methods: Totally 145 patients with diabetes or DN were selected as the pathological objects and divided into 3 groups according to disease severity:41 cases of moderate-severe DN,44 cases of mild DN and 60 cases of simple diabetes.In addition,60 healthy volunteers during the same period were selected as the control group.The expression level of miR-21 mRNA was determined by fluorescence quantitative PCR.The serum creatinine,urine nitrogen,uric acid and cystatin levels were detected by enzyme linked immunoassay analyzer,and the transforming growth factor beta(TGF-β),hyaluronic acid(HA),collagen type Ⅳ(CⅣ)and collagen type Ⅲ(PCⅢ)levels were detected by chemiluminescent analyzer. Results: The expression level of miR-21 mRNA of mild DN and moderate-severe DN was higher than the control group and pure diabetes,and the expression level of miR-21 mRNA in the moderate and severe DN group was higher than the mild DN,and the difference was statistically significant( P <0.05).The serum creatinine,urine nitrogen,uric acid,cystatin,TGF-β,HA,CⅣ and PCⅢ levels of pure diabetes,the mild DN and moderate-severe DN were all higher than the control group,and the mild DN and moderate-severe DN were higher than pure diabetes,and moderate-severe DN were higher than mild DN,the difference was statistically significant( P <0.05).Pearson test results showed that the diabetes nephrosis patient peripheral blood miR-21 mRNA expression level had linear positive correlation with serum creatinine,urine nitrogen,the elf inhibition,TGF-beta,C Ⅳ,PC Ⅲ( P <0.05).ROC curve analysis results showed that the expression of miR-21 mRNA had predictive value for mild DN and moderate-severe DN( P <0.05). Conclusion: The miR-21 expression level in peripheral blood is closely related to the degree of renal interstitial injury,and it is expected to be an important reference index for predicting the occurrence and development of DN.