移植肾早期急性排斥反应患者血清微小RNA-21水平变化及其临床意义

Variances in serum microRNA-21 level and its clinical significance in patients with early acute rejection after renal transplantation

目的探讨移植肾早期急性排斥反应患者血清微小RNA(miRNA)-21水平变化及其临床意义。方法选取78例肾移植术后患者作为研究对象,根据肾移植术后1个月内是否发生移植肾排斥反应将其分为急性排斥组33例和非排斥组45例。比较两组患者手术前后的血清miRNA-21相对表达水平,并采用受试者工作特征(ROC)曲线评价术后血清miRNA-21预测移植肾早期急性排斥反应的临床价值。根据术后1周血清miRNA-21表达水平,将患者分为miRNA-21高表达和低表达组,比较两组的无急性排斥反应生存率。结果术后1周,两组患者的血清miRNA-21相对表达水平均高于术前,且急性排斥组患者的血清miRNA-21相对表达水平高于非急性排斥组(均P<0.05)。ROC曲线分析结果显示,术后血清miRNA-21预测移植肾早期急性排斥反应的曲线下面积为0.715(P<0.05),最佳临界值为2.04,特异度为81.93%,灵敏度为93.65%。生存分析结果显示,miRNA-21高表达组患者的肾移植术后30 d内无急性排斥反应生存率低于miRNA-21低表达组(P<0.05)。结论在移植肾早期急性排斥反应患者血清miRNA-21表达上调,其或可成为预测移植肾早期急性排斥反应的生物学标记物。

Objective To investigate the variances in serum microRNA-21(miRNA)level and its clinical significance in patients with early acute rejection after renal transplantation.Methods Seventy-eight patients after renal transplantation were enrolled as research subjects,according to the presence of renal transplant rejection occurred within one month after renal transplantation,the patients were divided into acute rejection group(n=33)and non-rejection group(n=45).The relative expression levels of pre-and postoperative serum miRNA-21 were compared between the two groups,and the clinical value of postoperative serum miRNA-21 for predicting early acute rejection after renal transplantation was evaluated by using receiver operating characteristic(ROC)curve.According to the expression level of serum miRNA-21 one week after operation,the patients were divided into high-expression miRNA-21 group and low-expression miRNA-21 group,and the survival rate of the subjects without acute rejection was compared between the two group.Results The relative expression level of serum miRNA-21 one week after operation was higher than the preoperative level in the two groups,moreover,the acute rejection group exhibited a higher relative expression level of serum miRNA-21 than the non-acute rejection group(all P<0.05).The results of ROC curve analysis showed that postoperative serum miRNA-21 had an area under the curve of 0.715 for predicting early acute rejection after renal transplantation(P<0.05),with an optimal cut-off value of 2.04,specificity 81.93%,and sensitivity 93.65%.The results of survival analysis showed that the high-expression miRNA-21 group yielded a lower survival rate of the subjects without acute rejection within 30 days after renal transplantation than the low-expression miRNA-21 group(P<0.05).Conclusion Serum miRNA-21 is highly expressed in patients with early acute rejection after renal transplantation,which may become a predictive biomarker for early acute rejection after renal transplantation.