外泌体miRNA-21对狼疮性肾炎患者早期肾纤维化的诊断价值

Diagnostic Value of Exosomal miRNA-21 in Early Renal Fibrosis of Lupus Nephritis Patients

【目的】探讨外泌体miRNA-21对狼疮性肾炎(LN)早期纤维化的诊断价值。【方法】本院肾内科收治的54例LN患者,依据肾脏慢性纤维化指数(CI)将患者分为低CI组(CI<2分,n=20)、中CI组(2分≤CI<4分,n=27)及高CI组(CI≥4分,n=7)。检测所有患者尿液中miRNA-21水平,分析miRNA-21在不同肾纤维程度的表达差异,采用Pearson相关性分析miRNA-21与临床指标的关系,通过受试者工作特征(ROC)曲线分析miRNA-21诊断LN早期肾纤维化的价值。【结果】高CI组估测肾小球滤过率(eGFR)水平显著低于低CI组和中CI组(P<0.05),但24 h尿蛋白及miRNA-21水平显著高于低CI组和中CI组,且差异均有统计学意义(P<0.05);中CI组eGFR水平低于低CI组(P<0.05),24 h尿蛋白及miRNA-21水平高于低CI组(P<0.05)。Pearson相关性分析显示,外泌体miRNA-21与SLEDAI评分、抗dsDNA抗体、血尿素氮(BUN)、血肌酐(Scr)、CI评分及24 h尿蛋白呈显著正相关(P<0.05),但与eGFR呈显著负相关(P<0.05)。外泌体miRNA-21是影响LN早期肾纤维化的独立因素,其优势比(OR)(95%CI)为2.93(1.18~5.36);外泌体miRNA-21识别LN早期纤维化的曲线下面积(AUC)为0.85,其最佳界值为5.76。【结论】外泌体miRNA-21是诊断LN患者早期肾纤维化的潜在指标。

【Objective】This study aims to investigate the diagnostic value of exosomal miRNA-21 in early fibrosis of lupus nephritis(LN).【Methods】A total of 54 LN patients admitted to our nephrology department were enrolled.Based on the chronic fibrosis index(CI)of the kidneys,patients were divided into the low CI group(CI<2 scores,n=20),the moderate CI group(2 scores≤CI≤4 scores,n=27),and the high CI group(CI>4 scores,n=7).The level of miRNA-21 in urine samples from all patients were measured,and the differential expression of miRNA-21 in different degrees of renal fibrosis was analyzed.Pearson correlation analysis was performed to assess the relationship between miRNA-21 and clinical indicators.The diagnostic value of miRNA-21 in early renal fibrosis of LN was evaluated using receiver operating characteristic(ROC)curve analysis.【Results】The high CI group had significantly lower estimated glomerular filtration rate(eGFR)level than that of the low CI and moderate CI groups(P<0.05).While the 24-hour urinary protein and miRNA-21 level in the high CI group were significantly higher than that in the low CI and moderate CI groups.The differences were statistically significant(P<0.05).The moderate CI group had lower eGFR level than the low CI group(P<0.05)and higher 24-hour urinary protein and miRNA-21 level than the low CI group(P<0.05).Pearson correlation analysis revealed a significant positive correlation of exosomal miRNA-21 with SLEDAI score,anti-dsDNA antibodies,blood urea nitrogen(BUN),serum creatinine(Scr),CI scores,and urinary protein(P<0.05).However,a significant negative correlation was observed between miRNA-21 and eGFR(P<0.05).Exosomal miRNA-21 was identified as an independent factor affecting early renal fibrosis in LN,with an odds ratio(OR)(95%CI)of 2.93(1.18-5.36).The area under the curve(AUC)for exosomal miRNA-21 in identifying early fibrosis of LN was 0.85,with the optimal cutoff value at 5.76.【Conclusion】Exosomal miRNA-21 shows potential value as a diagnostic marker for early renal fibrosis in LN patients.