microRNA-93-5p联合在早期糖尿病肾病诊断中的研究

Combination of urinary RBP, serum microRNA-183, and serum microRNA-93-5p had a good performance in diagnosis of early-stage of diabetic nephropathy

目的 研究尿视黄醇结合蛋白(RBP)、血微小RNA-183(microRNA-183)、微小RNA-93-5p(microRNA-93-5p)联合应用在诊断早期糖尿病肾病(DN)中的价值。方法 将医院2019.01-2021.01间收治的133例2型糖尿病(T2DM)患者纳为研究对象,根据其24 h尿蛋白排泄率(UAER)将其分为单纯糖尿病组(T2DM组,UAER≤30 mg/24 h,n=38)与早期DN组(30 mg/24 h300 mg/24h,n=49),并将同期50例健康体检合格者纳为对照组。检测所有被研究对象尿RBP、血microRNA-183、microRNA-93-5p水平,绘制受试者工作特征曲线(ROC),分析尿RBP、血microRNA-183、microRNA-93-5p联合应用在诊断早期DN中的价值。结果对照组、T2DM组、早期DN组患者尿白蛋白/尿肌酐(UACR)水平均低于临床DN组。对照组、T2DM组患者UACR水平均低于早期DN组,差异均具有统计学意义(P<0.05)。对照组及T2DM组尿RBP、血microRNA-183及microRNA-93-5p水平比较,差异无统计学意义(P>0.05),两组尿RBP水平均低于早期DN组及临床DN组,血microRNA-183及microRNA-93-5p水平均高于早期DN组及临床DN组,且早期DN组尿RBP水平均低于临床组,血microRNA-183及microRNA-93-5p水平均高于临床DN组,差异均具有统计学意义(P<0.05)。相关性分析提示,尿RBP水平与UACR水平之间呈正相关,血microRNA-183、microRNA-93-5p水平与UACR呈负相关(P<0.05)。绘制ROC曲线发现,尿RBP、血microRNA-183及microRNA-93-5p在诊断早期DN中的AUC均超过0.75,其诊断价值均高于UACR,且尿RBP、血microRNA-183及microRNA-93-5p三者联合应用可有效提高各指标单独应用时的效能,提高早期DN诊断效果。结论 尿RBP、血microRNA-183及microRNA-93-5p在诊断早期DN中的效能均高于UACR,三者连个应用可成为诊断早期DN的潜在指标。

Objective To investigate the role of combination of urinary retinol-binding protein(RBP), serum microRNA-183, and serum microRNA-93-5p in diagnosis of early-stage diabetic nephropathy(DN). Methods One hundred and thirty-three patients with type 2 diabetes mellitus(T2DM) admitted to our hospital from January 2019 to January 2021 were included, and divided into three groups according to 24h urinary albumin excretion rate(UAER). They were diabetes mellitus group(T2DM group, UAER≤30mg/24h, n=38), early DN group(30mg/24h300 mg/24h, n=49). Meantime, another fifty healthy subjects underwent physical examination in our hospital during the same period were enrolled as control group. Urinary RBP, serum microRNA-183and microRNA-93-5p were detected in all subjects. Receiver operating characteristic curve(ROC) was used to evaluate the performance of combination of urinary RBP, serum microRNA-183, and serum microRNA-93-5p in diagnosis of early-stage DN. Results The urinary albumin/urinary creatinine(UACR) levels of individuals in the control group, T2DM group, and early DN group were lower than those in the clinical DN group. The UACR of individucals in the control group and T2DM group were lower than those in the early DN group(P<0.05). Levels of urinary RBP, serum microRNA-183, and serum microRNA-93-5p of control group and T2DM group showed no difference(P>0.05). Urinary RBP of control group and T2DM group was lower than that of the early DN group and clinical DN group, and serum microRNA-183 and microRNA-93-5p levels were higher than those of the early DN group and clinical DN group(P<0.05). Urinary RBP level of early DN group was lower than that of the clinical DN group, and serum microRNA-183 and microRNA-93-5p levels were higher than those of the clinical DN group(P<0.05). Correlation analysis showed a positive correlation between urinary RBP levels and UACR levels, and a negative correlation between serum microRNA-183, microRNA-93-5p levels and UACR(P<0.05). ROC curve showed that all AUCs of urinary RBP, serum microRNA-183, and microRNA-93-5p in the diagnosis of early-stage DN exceeded 0.75, and their diagnostic value was higher than that of UACR. The efficacy of combination of urinary RBP, serum microRNA-183, and microRNA-93-5p in the diagnosis of early-stage DN was higher than each of them along. Conclusion Urinary RBP, serum microRNA-183, and microRNA-93-5p in diagnosis of early-stage DN achieves better efficacy than UACR, and combination of them can be potential diagnostic marker for early-stage DN.