糖尿病肾病患者血清miR-29a水平与微血管病变的相关性

Correlation between serum miR⁃29a level and microangiopathy in diabetic nephropathy patients

目的 探讨糖尿病肾病(DN)患者血清miR-29a水平与微血管病变的相关性。方法 以河南省平煤神马医疗集团总医院收治的204例DN患者为观察组,同期选择204名体检健康人群为对照组。比较两组一般资料及miR-29a水平。DN患者根据尿蛋白排泄率(UAER)水平分为临床蛋白尿(微血管病变)组(69例)、微量蛋白尿组(86例)和正常蛋白尿组(49例),比较一般资料及miR-29a水平,并分析观察组中miR-29a与单因素具有统计学差异的指标之间相关性。Logistic回归分析微血管病变发生的影响因素。采用ROC曲线分析miR-29a在评估微血管病变中的临床价值。结果 相较于对照组,观察组收缩压、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、尿酸、血肌酐、胱抑素C、miR-29a水平更高,而低密度脂蛋白、肾小球滤过率水平更低,差异有统计学意义(t=9.475、6.296、35.083、39.770、9.548、6.073、44.190、22.329、28.088、14.560、14.479、8.600, P均<0.05);不同尿蛋白组患者病程、空腹血糖、胱抑素C、miR-29a水平比较,临床蛋白尿组>微量蛋白尿组>正常蛋白尿组;而低密度脂蛋白、肾小球滤过率水平比较,临床蛋白尿组<微量蛋白尿组<正常蛋白尿组,差异有统计学意义(F=45.678、49.246、43.017、122.661、64.022、66.978, P均<0.05)。相关性分析结果显示,miR-29a与病程、空腹血糖、低密度脂蛋白、胱抑素C水平呈正相关,而与肾小球滤过率水平呈负相关(r=0.447、0.346、0.423、0.572、-0.559,P<0.05)。Logistic回归法分析结果显示,肾小球滤过率、胱抑素C、miR-29a是微血管病变发生的独立危险因素。ROC曲线分析结果显示,miR-29a截断值为30.65时,评估患者微血管病变的AUC为0.89。结论DN患者miR-29a水平升高,与患者病情程度密切相关,可作为辅助指标评估DN患者微血管病变。

Objective To investigate the correlation between serum miR-29a level and microangi-opathy in diabetic nephropathy(DN)patients.Methods A total of 204 patients with DN admitted to Henan Pingmei What Medical Group General Hospital were selected as the observation group,and 204 healthy subjects were selected as the control group during the same period.General data and miR-29a levels were compared be-tween the two groups.According to the urinary protein excretion rate(UAER)level,DN patients were divided into clinical albuminuria(microangiopaopathy)group(69 cases),microalbuminuria group(86 cases)and nor-mal albuminuria group(49 cases).General data and miR-29a levels were compared,and the correlation be-tween miR-29a and indicators with statistical difference of single factor was analyzed in the observation group.Logistic regression was used to analyze the influencing factors of microangiopathy.ROC curve analysis was used to evaluate the clinical value of miR-29a in the assessment of microvascular diseases.Results Compared to the control group,the observation group had higher levels of systolic blood pressure,diastolic blood pres-sure,fasting blood glucose,glycated hemoglobin,total cholesterol,triglycerides,uric acid,serum creatinine,cystatin C and miR-29a.Conversely,the levels of low-density lipoprotein and glomerular filtration rate were lower(t=9.475,6.296,35.083,39.770,9.548,6.073,44.190,22.329,28.088,14.560,14.479,8.600,P<0.05).When comparing the disease course,fasting blood glucose,cystatin C and miR-29a levels among differ-ent urinary protein groups,it was found that the clinical albuminuria group>microalbuminuria group>normal albuminuria group.When comparing the levels of low-density lipoprotein and glomerular filtration rate:the clinical albuminuria group<microalbuminuria group<normal albuminuria group(F=45.678,49.246,43.017,122.661,64.022,66.978,P<0.05).Correlation analysis showed that miR-29a was positively correlated with the disease course,fasting blood glucose,low-density lipoprotein and cystatin C levels,but negatively corre-lated with glomerular filtration rate(r=0.447、0.346、0.423、0.572、-0.559,P<0.05).Logistic regression analy-sis showed that glomerular filtration rate,cystatin C and miR-29a were independent risk factors for microangi-opathy.The ROC curve analysis results showed that when the cut-off value of miR-29a was 30.65,the AUC for evaluating patients with microangiopathy was 0.89.Conclusion The increased levels of miR-29a in DN pa-tients are closely related to the severity of their disease.This bopmarker can serve as an additional indicator to as-sess microangiopathy in DN patients.