IgA肾病患者血清微小RNA-155-5p的检测及临床意义

张婉芬; 唐羽裳; 李小平; 井冉; 刘同强

doi:10.3969/j.issn.1671-2390.2023.10.009

摘要:

目的检测IgA肾病患者血清微小RNA（microRNA，miR）-155-5p水平，并分析其临床意义。

方法选取南京医科大学附属常州二院随访3年的IgA肾病患者，应用实时荧光定量PCR方法检测患者血清miR-155-5p表达水平。根据肾功能下降速度，分为肾功能进展组和肾功能相对稳定组。比较两组患者的临床及实验室指标的差异，应用Logistic回归模型分析引起肾功能进展的危险因素。应用Pearson或Spearman相关分析血清miR-155-5p水平与基线估算肾小球滤过率（estimated glomerular filtration rate，eGFR）、尿蛋白定量、肾功能下降速度、肾脏病理资料等的相关性。应用受试者工作特征曲线（receiver operating characteristic curve，ROC）评估miR-155-5p水平判断肾功能进展的能力。

结果共纳入肾功能进展患者42例，肾功能相对稳定患者63例。与肾功能相对稳定组患者相比，肾功能进展组患者高血压患病率（88.09%比19.05%）、基线尿蛋白定量（3.11±2.16）g/24 h比（1.07±0.87）g/24 h、基线血肌酐（106.74±51.27）μmol/L比（86.90±36.90）μmol/L、肾脏病理评分T总分（61比13）较高（P＜0.05），基线eGFR（74.76±32.74）mL·min⁻¹·（1.73m²）⁻¹比（92.28±29.65）mL·min⁻¹·（1.73m²）⁻¹、血清miR-155-5p水平（489.19±123.13）fmol/L比（792.60±199.44）fmol/L较低（P＜0.05）。将两组相比差异有统计学意义的变量纳入多因素Logistic回归模型进行分析，结果显示高血压、尿蛋白定量、基线eGFR、病理评分T、血清miR-155-5p是IgA肾病肾功能进展的独立风险因素。血清miR-155-5p水平与eGFR下降速度呈负相关（r=−0.456，P＜0.001）。miR-155-5p对肾功能进展预测的ROC曲线显示曲线下面积=0.918，灵敏度= 0.841，特异度=0.881，最佳截断值为582.04 fmol/L。

结论 IgA患者血清miR-155-5p水平与IgA患者肾功能进展负相关，可能成为判断IgA患者肾功能进展的新型生物标志物。

Abstract:

Objective To detect the serum level of microRNA (miR)-155-5p in IgA nephropathy patients and examine its clinical significance.

Methods The patients with IgA nephropathy followed up for 3 years were selected. Serum level of miR-155-5p was detected by real-time fluorescent quantitative polymerase chain reaction (PCR). Based upon declining rate of renal function (RF), they were assigned into two groups of RF progression (A, n=42) and relatively stable RF (B, n=63). Inter-group differences in clinical and laboratory parameters were compared. Logistic regression analysis was performed for identifying the risk factors for RF progression. Pearson’s or Spearman’s correlation analysis was performed for assessing the correlation between serum level of miR-155-5p and baseline estimated glomerular filtration rate (eGFR), urinary protein quantification, declining rate of RF and renal pathological data. Receiver operating characteristic (ROC) curve was plotted for evaluating the capability of miR-155-5p level for judging the progress of RF.

Results As compared with group B, group A had a higher prevalence of hypertension (88.09% vs 19.05%), greater baseline urinary protein quantification (3.11±2.16)g/24 h vs (1.07±0.87)g/24 h, higher baseline blood creatinine (106.74±51.27)μmol/L vs (86.90±36.90)μmol/L and higher total kidney pathology T score (61 vs 13, P<0.05). Baseline eGFR (74.76±32.74)mL·min⁻¹·（1.73m²）⁻¹ vs (92.28±29.65)mL·min⁻¹·（1.73m²）⁻¹ and serum level of miR-155-5p (489.19±123.13)fmol/L vs (792.60±199.44)fmol/L were lower in group A (P<0.05). Variables with statistically significant inter-group differences were included for multifactorial Logistic regression analysis. It indicated that hypertension, urinary protein quantification, baseline eGFR, pathology score T and serum level of miR-155-5p were independent risk factors for RF progression of IgA nephropathy. Serum level of miR-155-5p was correlated negatively with declining rate of eGFR (r=−0.456, P<0.001). ROC curve for miR-155-5p in predicting RF progression had an area under the curve (AUC) of 0.918 with a sensitivity of 0.841, a specificity of 0.881 and an optimal cutoff value of 582.04 fmol/L.

Conclusion Correlated negatively with RF progression, serum level of miR-155-5p may serve as a novel biomarker for predicting RF progression in IgA patients.

IgA肾病患者血清微小RNA-155-5p的检测及临床意义

Detection and clinical significance of serum microRNA-155-5p in patients with IgA nephropathy