维持性腹膜透析患者血清微小核糖核酸-29b表达水平与腹主动脉钙化的相关性研究

Study on the correlation between the expression level of miR-29b in serum and abdominal aortic calcification in patients undergoing maintenance peritoneal dialysis

目的:探讨维持性腹膜透析患者血清微小核糖核酸(miR)-29b水平与腹主动脉钙化相关性。方法:选取2017年7月至2020年7月,在我院行维持性腹膜透析治疗的患者176例,收集临床资料,行腹部侧位X线片检查并采用半定量积分法评估腹主动脉钙化积分(AACS),根据AACS积分将患者分为非钙化组和钙化组,利用实时荧光定量PCR术检测血清中miR-29b表达量。结果:176例腹膜透析患者中,131例存在腹主动脉钙化,患病率74.4%,其中,轻度钙化38例,中度钙化52例,重度钙化41例。钙化组患者年龄、透析时间、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)、血钙(Ca)和血磷(P)均高于非钙化组,而ALB、残余肾功能、总尿素清除指数和miR-29b表达量均低于非钙化组,差异有统计学意义(P<0.05);轻度钙化、中度钙化和重度钙化患者血清中miR-29b表达量差异有统计学意义,轻度钙化>中度钙化>重度钙化;Pearson相关分析结果显示,AACS积分与年龄、透析时间、ALP、PTH、Ca和P呈正相关(r=0.386、0.496、0.265、0.398、0.381、0.297,P<0.05),而与ALB、残余肾功能、总尿素清除指数和miR-29b表达量呈负相关(r=-0.344、-0.307、-0.222和-0.358,P<0.05);Logistic回归分析结果显示,透析时间、ALP、残余肾功能和miR-29b表达量是腹主动脉钙化的影响因素(P<0.05);ROC曲线分析结果显示,血清中miR-29b表达量在预测发生腹主动脉钙化时,曲线下面积为0.856(95%CI:0.784~0.929),当miR-29b取0.95时,灵敏度为83.21%,特异度为77.78%。结论:维持性腹膜透析患者发生腹主动脉钙化时血清miR-29b表达量降低,且与病程进展程度有关,是腹主动脉钙化的独立危险因素,对腹主动脉钙化具有良好的预测价值。

Objective:To investigate the correlation between the expression level of miR-29 b in serum and abdominal aortic calcification in patients undergoing maintenance peritoneal dialysis.Methods:A total of 176 cases of patients who underwent maintenance peritoneal dialysis in our hospital were selected from July 2017 to July 2020.The clinical data was collected.All patients were accepted abdominal lateral X-ray examination and the abdominal aortic calcification score(AACS)was evaluated by using semi-quantitative integration method.And the patients were divided into non-calcified group and calcified group based on AACS score.The expression of miR-29 b in serum was detected by using real-time fluorescence quantitative PCR.Results:Among 176 patients who underwent peritoneal dialysis,131 had abdominal aortic calcification,the prevalence rate was 74.4%.Among them,38 had mild calcification,52 had moderate calcification,and 41 had severe calcification.The age,dialysis time,ALP,PTH,Ca and P in the calcified group were higher than those in the non-calcified group,while the ALB,residual renal function,total urea clearance index and the expression level of miR-29 b were lower than those in the non-calcified group,the differences were statistically significant(P<0.05).The difference of the expression levels of miR-29 b in serum in the mild calcification,moderate calcification and severe calcification was statistically significant,and the mild calcification>moderate calcification>severe calcification.The result of Pearson correlation analysis showed that the AACS score was positively correlated with age,dialysis time,ALP,PTH,Ca and P(r=0.386,0.496,0.265,0.398,0.381,0.297,P<0.05),while was negatively correlated with ALB,residual renal function,total urea clearance index and the expression level of miR-29 b(r=-0.344,-0.307,-0.222 and-0.358,P<0.05).The result of Logistic regression analysis showed that the dialysis time,ALP,residual renal function and the expression level of miR-29 b were independent influencing factors of abdominal aortic calcification(P<0.05).ROC curve analysis result show that when the expression level of miR-29 b in serum predicting the occurrence of abdominal aortic calcification,the area under the curve was 0.856(95%CI:0.784-0.929).When miR-29 b was 0.95,the sensitivity was 83.21%,and the specificity was 77.78%.Conclusions:The expression level of miR-29 b in serum is decreased when abdominal aortic calcification occurred in maintenance peritoneal dialysis patients,and is related to the progression of the disease.It is an independent risk factor for abdominal aortic calcification and has good predictive value for abdominal aortic calcification.