血清miR-210、miR-218-5p和KIM-1水平对妊娠期高血压疾病患者肾损伤的诊断价值

Diagnostic value of serum miR-210,miR-218-5p and KIM-1 levels on kidney injury in patients with hypertensive diseases during pregnancy

目的评估血清微小RNA(miR)-210、miR-218-5p和肾损伤分子(KIM)-1水平对妊娠期高血压疾病患者肾损伤的诊断价值。方法选择2019年1月至2020年12月复旦大学附属妇产科医院诊断为妊娠期高血压疾病的患者106例为研究组,选择同期健康产检孕妇75例为对照组。比较研究组与对照组血清miR-210、miR-218-5p、KIM-1和β_(2)-微球蛋白(β_(2)-MG)水平;分析血清miR-210、miR-218-5p、KIM-1和β_(2)-MG水平与妊娠期高血压疾病严重程度及肾功能的关系;评估血清miR-21、miR-218-5p、KIM-1和β_(2)-MG水平对妊娠期高血压疾病患者肾损伤的诊断效能;分析妊娠期高血压疾病患者血清miR-210、miR-218-5p和KIM-1水平间的相关性。结果研究组血清miR-210、KIM-1和β_(2)-MG水平明显高于对照组,血清miR-218-5p水平明显低于对照组,差异有统计学意义(P<0.05)。重度子痫前期组血清miR-210、KIM-1和β_(2)-MG水平明显高于轻度子痫前期组和妊娠期高血压组,血清miR-218-5p水平明显低于轻度子痫前期组和妊娠期高血压组,差异有统计学意义(P<0.05);轻度子痫前期组血清miR-210、KIM-1和β_(2)-MG水平明显高于妊娠期高血压组,血清miR-218-5p水平明显低于妊娠期高血压组,差异有统计学意义(P<0.05)。肾功能异常组血清miR-210、KIM-1和β_(2)-MG水平明显高于肾功能正常组,血清miR-218-5p水平明显低于肾功能正常组,差异有统计学意义(P<0.05)。血清miR-210、KIM-1、miR-218-5p联合检测诊断妊娠期高血压疾病患者肾损伤的灵敏度为84.6%,特异度为95.5%,曲线下面积为0.957,明显优于各指标单独检测(P<0.05)。妊娠期高血压疾病患者血清miR-210和KIM-1水平与miR-218-5p水平均呈负相关(r=-0.555、-0.542,P<0.05),而血清miR-210与KIM-1水平呈正相关(r=0.575,P<0.05)。结论血清miR-210、miR-218-5p和KIM-1水平与妊娠期高血压疾病的发生、发展有关,且对患者肾损伤具有较高的诊断价值,联合检测的诊断价值优于各指标单独检测。

Objective To evaluate the diagnostic value of serum microRNA(miR)-210,miR-218-5p and kidney injury molecule(KIM)-1 levels on kidney injury in patients with hypertensive diseases during pregnancy.Methods A total of 106 patients with hypertensive diseases during pregnancy diagnosed by the Fudan Affiliated Obstetrics and Gynecology Hospital from January 2019 to December 2020 were selected as the study group,and 75 healthy pregnant women underwent prenatal examination in the same period were selected as the control group.Serum levels of miR-210,miR-218-5p,KIM-1,β_(2)-microglobulin(β_(2)-MG)were compared between the study group and the control group.The relationship between serum levels of miR-210,miR-218-5p,KIM-1 andβ_(2)-MG and the severity and kidney function of hypertensive diseases during pregnancy was analyzed.The diagnostic efficacy of serum miR-21,miR-218-5p,KIM-1 andβ_(2)-MG levels on kidney injury in hypertensive diseases during pregnancy were evaluated.The correlation between serum miR-210,miR-218-5p and KIM-1 levels in patients with hypertensive diseases during pregnancy was analyzed.Results The serum levels of miR-210,KIM-1 andβ_(2)-MG in the study group were significantly higher than those in the control group,while the serum level of miR-218-5p was significantly lower than that in the control group,the differences were statistically significant(P<0.05).The serum levels of miR-210,KIM-1 andβ_(2)-MG in the severe preeclampsia group were significantly higher than those in the mild preeclampsia group and gestational hypertension group,while the serum level of miR-218-5p was significantly lower than that in the mild preeclampsia group and gestational hypertension group,the differences were statistically significant(P<0.05).The serum levels of miR-210,KIM-1 andβ_(2)-MG in the mild preeclampsia group were significantly higher than those in the gestational hypertension group,while the serum level of miR-218-5p was significantly lower than that in the gestational hypertension group,the differences were statistically significant(P<0.05).The serum levels of miR-210,KIM-1 andβ_(2)-MG in the abnormal kidney function group were significantly higher than those in the normal kidney function group,while the serum level of miR-218-5p was significantly lower than that in the normal kidney function group,the differences were statistically significant(P<0.05).The sensitivity,specificity and AUC of the combined detection of serum miR-210,KIM-1 and miR-218-5p were 84.6%,95.5%and 0.957 respectively,the AUC was significantly better than that of each index alone(P<0.05).The serum levels of miR-210 and KIM-1 were negatively correlated with miR-218-5p(r=-0.555,-0.542,P<0.05),while the serum level of miR-210 was positively correlated with KIM-1(r=0.575,P<0.05).Conclusion Serum miR-210,miR-218-5p and KIM-1 levels are associated with the occurrence and development of hypertensive diseases during pregnancy,and have high diagnostic value in patients with kidney injury.The diagnostic value of combined detection is better than that of each indicator alone.