维持性血液透析患者血清微小RNA-29b水平与矿物质骨代谢紊乱指标的相关性分析

彭瑞; 高国胜

doi:10.3969/j.issn.1671-2390.2023.06.003

维持性血液透析患者血清微小RNA-29b水平与矿物质骨代谢紊乱指标的相关性分析

彭瑞,
高国胜

Correlation analysis between serum miR-29b level and parameters of mineral and bone metabolism disorders in patients on maintenance hemodialysis

摘要

摘要:
目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者血清微小RNA（microRNA，miR）-29b水平与慢性肾脏病-矿物质骨代谢紊乱（chronic kidney disease-mineral and bone metabolism disorder，CKD-MBD）指标的相关性。
方法选取2019年2月至2021年11月鄂州市中心医院血液净化中心进行规律MHD的患者116例作为MHD组，根据血钙、磷、全段甲状旁腺素（intact parathyroid hormone，iPTH）指标范围将其分为达标组（未合并CKD-MBD）与未达标组（合并CKD-MBD）。另选取体检健康者116名为对照组。检测血清miR-29b、钙、磷、iPTH、血红蛋白（hemoglobin，Hb）、碱性磷酸酶（alkaline phosphatase，ALP）、白蛋白（albumin，Alb）、β2微球蛋白（β2-microglobulin，β2-MG）、25羟维生素D25 hydroxyvitamin D，25（OH）D水平，比较其在各组中的差异。Pearson法分析未达标组miR-29b与各临床指标相关性；logistic回归模型分析miR-29b降低的相关影响因素。
结果 MHD组患者以下指标水平高于对照组：血磷（1.50 ± 0.37）mmol/L比（1.12 ± 0.26）mmol/L、ALP（96.07 ± 13.54）U/L比（72.39 ± 11.95）U/L、β2-MG（1.73 ± 0.51）mg/L比（1.48 ± 0.36）mg/L、25（OH）D（21.30 ± 5.47）μg/L比（16.82 ± 3.15）μg/L、iPTH（325.08 ± 84.90）ng/L比（50.74 ± 9.36）ng/L；以下指标水平低于对照组：Hb（114.93 ± 7.26）g/L比（125.74 ± 10.51）g/L、Alb（37.25 ± 3.82）g/L比（43.18 ± 4.04）g/L、miR-29b（0.72 ± 0.15）比（1.06 ± 0.12），差异有统计学意义（P＜0.05）。116例MHD患者中9例（7.76%）同时达到CKD-MBD指南中规定的钙、磷、iPTH目标值。达标组血清miR-29b表达水平（0.92 ± 0.17）高于未达标组（0.70 ± 0.15），差异有统计学意义（P＜0.05）。未达标组血清miR-29b与25（OH）D、磷、iPTH存在负相关（r＝−0.592、r＝−0.546、r＝−0.601，P均＜0.05），与年龄、体重指数、透析时间、Hb、ALP、Alb、钙、β2-MG不存在相关性（P均＞0.05）。25（OH）DOR（95%CI）：1.627（1.110～2.384）、磷OR（95%CI）：1.461（1.064～2.007）、iPTHOR（95%CI）：1.539（1.092～2.169）是导致miR-29b降低的危险因素（P＜0.05）。
结论 miR-29b在合并矿物质骨代谢紊乱的MHD患者中呈下调表达，且与25（OH）D、磷、iPTH呈负相关。

Abstract:
Objective To explore the correlation between serum microRNA（miR）-29b level and chronic kidney disease-mineral and bone metabolic disorder（CKD-MBD） parameters in maintenance hemodialysis（MHD） patients.
Methods From February 2019 to November 2021, 116 patients with regular MHD at our blood purification center were selected as MHD group. According to the range of serum calcium, phosphorus and intact parathyroid hormone（iPTH）, they were assigned into two groups of target（without CKD-MBD） and non-target（with CKD-MBD）. Also 116 healthy subjects were included into control group. The levels of serum miR-29b, calcium, phosphorus, iPTH, hemoglobin（Hb）, alkaline phosphatase（ALP）, albumin（Alb）, β2 microglobulin（β2-MG） and 25-hydroxyvitamin D25（OH）D were detected and inter-group differences compared. Pearson’s method was employed for examining the correlation between miR-29b and various clinical parameters in substandard group. Logistic regression was utilized for examining the related influencing factors of miR-29b reduction.
Results In MHD group, phosphorus（1.50 ± 0.37）mmol/L vs （1.12 ± 0.26）mmol/L, ALP（96.07 ± 13.54） U/L vs （72.39 ± 11.95） U/L, β2-MG（1.73 ± 0.51）mg/L vs （1.48 ± 0.36）mg/L, 25（OH）D（21.30 ± 5.47）μg/L vs （16.82 ± 3.15）μg/L, iPTH（325.08 ± 84.90） ng/Lvs （50.74 ± 9.36）ng/L were higher than those in control group; the expression levels of Hb（114.93 ± 7.26）g/L vs （125.74 ± 10.51） g/L, Alb（37.25 ± 3.82）g/L vs （43.18 ± 4.04）g/L and miR-29b（0.72 ± 0.15） vs （1.06 ± 0.12） were lower than those of control group. And the difference was statistically significant （P＜0.05）. Nine of them（7.76%） simultaneously attained the target values of calcium, phosphorus and iPTH specified within the CKD-MBD guidelines. The expression level of serum miR-29b in standard group（0.92 ± 0.17） was greatly higher than that in non-standard group （0.70 ± 0.15） and the difference was statistically significant（P＜0.05）. A negative correlation existed between miR-29b and 25（OH）D, phosphorus and iPTH in substandard group（r = −0.592, −0.546, −0.601, all P＜0.05）. However, there was no correlation with age, body mass index, dialysis time, Hb, ALP, Alb calcium or β2-MG（all P＞0.05）. 25（OH）DOR（95%CI）: 1.627（1.110-2.384）, phosphorusOR（95%CI）: 1.461（1.064-2.007） and iPTHOR（95%CI）: 1.539（1.092-2.169） were the risk factors for a decline of miR-29b（P＜0.05）.
Conclusion Down-regulated in MHD patients with mineral and bone metabolism disorders, MiR-29b is correlated negatively with 25（OH）D, phosphorus and iPTH.

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