狼疮性肾炎病人血清簇分化抗原36、微小RNA-335水平与疾病活动度的关系

Relationship between serum cluster differentiation antigen 36 and microRNA-335-levels and disease activity in patients with lupus nephritis

目的检测狼疮肾炎病人血清簇分化抗原36(CD36)、微小RNA(miR)-335水平,并分析二者与狼疮肾炎疾病活动度的关系。方法选取仙桃市第一人民医院2017年5月至2020年6月收治的系统性红斑狼疮(SLE)病人138例为研究对象,其中狼疮肾炎活动组92例,非活动组46例,同期选取在该院进行健康体检人员120例为对照组。常规检查所有受试者实验室指标;酶联免疫吸附测定(ELISA)检测血清CD36水平;实时荧光定量PCR(qRT-PCR)检测血清miR-335水平;Pearson相关性分析检验狼疮肾炎病人血清CD36、miR-335与一般资料的相关性;ROC曲线分析血清CD36、miR-335对狼疮肾炎疾病活动度的诊断价值。结果与对照组比较,狼疮肾炎病人血清CD36、miR-335水平均显著升高(P<0.05);活动组狼疮肾炎病人与非活动组比较,尿素氮[(8.89±2.14)mmol/L比(5.93±1.25)mmol/L]、血肌酐[(93.47±18.26)μmol/L比(52.19±21.35)μmol/L]、尿蛋白[(3.45±1.31)g/24 h比(1.28±0.43)g/24 h]、尿沉渣红细胞[95(55,132)×10^(4)/mL比36(18,65)×10^(4)/mL]、SLE疾病活动指数(SLEDAI)[12(10,15)分比5(4,7)分]、活动指数[10(8,13)分比2(1,3)分]均显著升高,补体C3[(436.12±53.72)mg/L比(674.38±68.91)mg/L]、C4[(75.66±21.43)mg/L比(122.47±30.12)mg/L]、白蛋白[(23.58±6.15)g/L比(31.24±7.83)g/L]水平显著降低(P<0.05);与非活动组比较,活动组狼疮肾炎病人CD36、miR-335水平显著升高,且随着疾病活动度的增加,血清CD36、miR-335水平均逐渐升高,且与狼疮肾炎病人白蛋白、补体C3、C4呈负相关,与血肌酐、尿蛋白、尿沉渣红细胞、SLEDAI、活动指数呈正相关(P<0.05);ROC曲线结果显示,血清CD36、miR-335水平诊断狼疮肾炎病人疾病活动度的曲线下面积(AUC)分别为0.83[95%CI:(0.75,0.90)]、0.80[95%CI:(0.73,0.88)],二者联合诊断AUC为0.94[95%CI:(0.90,0.98)]。结论狼疮肾炎病人血清CD36、miR-335水平随着狼疮肾炎疾病活动度的增加而逐渐升高,对狼疮肾炎疾病活动度有一定的诊断价值。

Objective Serum levels of cluster differentiation antigen 36(CD36)and microRNA(miR)-335 in lupus nephritis(LN)patients were detected and their relationship with LN disease activity was analyzed.Methods A total of 138 systemic lupus erythematosus(SLE)patients admitted to Xiantao First People’s Hospital from May 2017 to June 2020 were selected as the research subjects,including 92 cases in the LN active group and 46 cases in the inactive group,and 120 patients who underwent physical examination in the hospital were included as control group.All subjects were routinely examined for laboratory indicators;the level of serum CD36 was detected by enzyme-linked immunosorbent assay(ELISA);the level of serum miR-335 was detected by real-time quantitative PCR(qRT-PCR);Pearson correlation analysis was used to analyze the correlation between serum CD36,miR-335 and general data in patients with LN;ROC curve analysis of the diagnostic value of serum CD36 and miR-335 for LN disease activity.Results Compared with the control group,the serum levels of CD36 and miR-335 in LN patients were significantly increased(P<0.05);The LN patients in the active group were compared with those in the inactive group,in which blood urea nitrogen[(8.89±2.14)mmol/L vs.(5.93±1.25)mmol/L],serum creatinine[(93.47±18.26)μmol/L vs.(52.19±21,35)μmol/L],urine protein[(3.45±1,31)g/24 h vs.(1.28±0.43)g/24 h],urinary sediment red blood cell(RBC)count[95(55,132)×10^(4)/mL vs.36(18,65)×10^(4)/mL],SLE disease activity index(SLEDAI)[12(10,15)points vs.5(4,7)points],activity index[10(8,13)points vs.2(1,3)points]were significantly increased,while the levels of complement C3[(436.12±53.72)mg/L vs.(674.38±68.91)mg/L],C4[(75.66±21.43)mg/L vs.(122.47±30.12)mg/L]and albumin[(23.58±6.15)g/L vs.(31.24±7.83)g/L]were significantly decreased(P<0.05).Compared with the inactive group,the levels of CD36 and miR-335 in patients with LN in the active group were significantly increased,and with the increase in disease activity,the levels of serum CD36 and miR-335 were gradually increased,and they were significantly different from those of albumin and miR-335 in LN patients.Complement C3 and C4 were negatively correlated and positively correlated with serum creatinine,urine protein,urinary sediment RBC count,SLEDAI,and activity index(P<0.05).The ROC curve results showed that the areas under the curve(AUCs)of serum CD36 and miR-335 levels in the diagnosis of disease activity in patients with LN were 0.83[95%CI:(0.75,0.90)],0.80[95%CI:(0.73,0.88)],and the combined diagnosis AUC of the two was 0.94[95%CI:(0.90,0.98)].Conclusion The levels of serum CD36 and miR-335 in LN patients gradually increased with increasing LN disease activity,which has a certain diagnostic value for LN disease activity.