糖尿病肾病合并上尿路感染患者PINK1/Parkin mRNA与mAlb及其诊断价值

PINK1/Parkin mRNA and mAlb in diabetic nephropathy complicated with upper urinary tract infection patients and their diagnostic value

目的分析糖尿病肾病(DN)合并上尿路感染患者PINK1/Parkin mRNA与尿微量白蛋白(mAlb)的关系。方法选择2019年10月-2020年9月邢台市人民医院收治的DN合并上尿路感染患者73例作为研究组,选择同期医院收治的DN未合并上尿路感染患者141例作为对照组;依据糖尿病肾脏疾病肾小管间质和血管损害病理评分(RPS)将73例DN合并上尿路感染患者按照肾小管间质及血管受损程度分为轻度组(n=15)、中度组(n=28)和重度组(n=30);通过逆转录聚合酶链式反应(RT-PCR)技术检测上述患者外周血PINK1 mRNA及Parkin mRNA表达量,免疫比浊法检测mAlb,比较上述不同分组患者各指标。结果研究组患者PINK1 mRNA、Parkin mRNA及mAlb均高于对照组(P<0.05);重度组患者PINK1 mRNA、Parkin mRNA、mAlb和RPS评分均较轻、中度组升高,中度组较轻度组升高(P<0.05);经受试者工作特征(ROC)曲线分析,PINK1 mRNA、Parkin mRNA及二者预测DN患者合并上尿路感染患者肾功能损伤均有较高效能,其中二者联合诊断效能较高,其约登指数为0.678,曲线下面积(AUC)为0.853;PINK1 mRNA、Parkin mRNA与mAlb水平呈正相关(r=0.668、0.559,P均<0.05),与RPS评分也呈正相关(r=0.612、0.478,P均<0.05);PINK1mRNA、Parkin mRNA及二者联合指导DN合并上尿路感染肾功能损伤轻中度与重度的区分均有较高效能,三者联合诊断时效能最高。结论DN患者合并上尿路感染时PINK1/Parkin通路被激活,外周血单个核细胞的PINK1 mRNA、Parkin mRNA表达量异常升高,且与mAlb及肾功能损伤程度呈正相关,二者联合诊断DN合并上尿路感染患者肾功能损伤的程度具有较高效能。

OBJECTIVE To analyze the relationship between PINK1/Parkin mRNA and urinary microalbumin(mAlb)in patients with diabetic nephropathy(DN)complicated with upper urinary tract infection and renal function damage.METHODS Totally 73patients with DN complicated with upper urinary tract infection and renal function damage treated in Xingtai People′s Hospital between Oct.2019and Sep.2020were selected as the study group,and 141DN patients without upper urinary tract infection during the same period were selected as control group.The 73patients with DN complicated with upper urinary tract infection were divided into mild(n=15),moderate(n=28)and severe(n=30)groups according to the pathological scores(RPS)of the renal tubule interstitial and vascular damage in diabetic kidney disease.The expression levels of peripheral blood PINK1and Parkin mRNA in these patients were measured by reverse transcription-polymerase chain reaction(RT-PCR)technology,the level of mAlb was measured by immunoturbidimetry,and the indicators were compared among different groups of patients.RESULTS The PINK1mRNA,Parkin mRNA and mAlb in study group were all higher than those in control group(P<0.05).The PINK1mRNA,Parkin mRNA,mAlb and RPS score in severe group were higher than those in mild group and moderate group,and the PINK1mRNA,Parkin mRNA,mAlb and RPS score in moderate group were higher than those in mild group(P<0.05).The receiver operating characteristic curve(ROC)analysis showed that PINK1mRNA,Parkin mRNA and the combination of the two had high efficiency in predicting upper urinary tract infection in the DN patients,and the combined diagnostic efficiency of the two was the higher,with a Youden index of 0.678and an area under the curve(AUC)of 0.853.PINK1and Parkin mRNA were positively correlated with mAlb(r=0.668,0.559,all P<0.05),and were also positively correlated with RPS score(r=0.612,0.478,all P<0.05).PINK1mRNA,Parkin mRNA and the combination of the two had high efficiency in differentiating the mild,moderate and severe renal function damage of DN with upper urinary tract infection,and the diagnostic efficiency of the combined diagnosis was the highest.CONCLUSION The PINK1/Parkin pathway is activated in DN patients complicated with upper urinary tract infection when renal function was impaired,and the expression of PINK1and Parkin mRNA were abnormally elevated in peripheral blood mononuclear cells,and positively correlated with mAlb and the degree of renal function impairment.The combination of the two had high efficiency in diagnosing the degree of renal function impairment in patients with DN complicated with upper urinary tract infection.