远隔缺血预处理防治造影剂肾病中miRNA-134-5p的表达水平及临床意义

The miRNA-134-5p Expression Level in Prevention and Treatment of Radiographic Contrast Nephropathy by Remote Ischemic Preconditioning and Its Clinical Significance

目的:研究远隔缺血预处理(RIPC)防治造影剂肾病中miRNA-134-5p的表达水平及临床意义。方法:选取2019年12月-2020年8月在包头医学院第一附属医院心内三科择期接受冠状动脉介入治疗(PCI)的52例冠心病患者为研究对象,随机分为两组,各26例。空白对照组(PC组)在10 s内将袖带压充至20 mmHg,RIPC组在10 s内将袖带压充至200mmHg,两组均维持5 min后放气5 min,而后重复3次此循环。比较两组术后不同时间血肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)水平;分析尿液中miRNA-134-5p表达量与术后Scr及尿液中NGAL、KIM-1的相关性。结果:术后4 h、6 h、12 h、24 h、48 h,RIPC组Scr水平低于PC组,差异有统计学意义(P<0.05);术后6 h、12 h、24 h、48 h,RIPC组尿液NGAL水平低于PC组,差异有统计学意义(P<0.05);术后2 h、4 h、6 h、12 h、24 h、48 h,RIPC组尿液KIM-1水平均低于PC组,差异有统计学意义(P<0.05)。RIPC组患者尿液中miRNA-134-5p表达量高于PC组,差异有统计学意义(P<0.05)。尿液中miRNA-134-5p与Scr、尿液KIM-1的变化无相关性,与尿液NGAL的变化呈明显的正相关性。结论:RIPC可以使尿液中miRNA-134-5p表达水平上调,且与尿液中NGAL水平升高有关,RIPC致使miRNA-134-5p在造影剂所致急性肾脏缺血损伤的保护中起到重要作用。

Objective:To investigate the miRNA-134-5p expression level and clinical significance in the prevention and treatment of radiographic contrast nephropathy by remote ischemic preconditioning(RIPC).Methods:A total of 52 patients with coronary heart disease who received elective percutaneous coronary intervention(PCI)in the Third Department of Cardiology of the First Affiliated Hospital of Baotou Medical College from December 2019 to August 2020 were selected as the study subjects.They were randomly divided into two groups,with 26 cases in each group.In blank control group(PC group),the cuff was inflated to 20 mmHg in 10 seconds;in RIPC group,the cuff was inflated to 200 mmHg in 10 seconds.Both groups were maintained for 5 min,and then deflated for 5 min,and the cycle was repeated 3 times.The levels of serum creatinine(Scr),neutrophil gelatinase-associated lipid carrier protein(NGAL)and kidney injury molecule 1(KIM-1)at different times after surgery were compared between the two groups.The correlation between miRNA-134-5p expression in urine and postoperative Scr,urinary NGAL and KIM-1 was analyzed.Results:At 4 h,6 h,12 h,24 h and 48 h after surgery,the Scr level in the RIPC group was lower than that in the PC group,and the difference was statistically significant(P<0.05).At 6 h,12 h,24 h and 48 h after surgery,the urinary NGAL level in the RIPC group was lower than that in the PC group,and the difference was statistically significant(P<0.05).At 2 h,4 h,6 h,12 h,24 h,and 48h after surgery,the urinary KIM-1 level in the RIPC group was lower than that in the PC group,and the difference was statistically significant(P<0.05).The expression of miRNA-134-5p in urine was higher in the RIPC group than in the PC group,and the difference was statistically significant(P<0.05).There was no correlation between miRNA-134-5p in urine and changes in Scr and urinary KIM-1,and there was an obvious positive correlation with changes in urinary NGAL.Conclusion:RIPC can up-regulate the expression level of miRNA-134-5p in urine,which is related to the increase of urinary NGAL level.RIPC induces miRNA-134-5p to play an important role on protection against radiographic contrast-induced acute renal ischemia injury.