【摘要】 目的探讨尿液微小RNA-34a(miR-34a)及血尿酸(uric acid,UA)水平与进行连续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)治疗的终末期肾病(end stage renal disease,ESRD)患者肾功能及预后的关系。方法以2016年1月～2017年1月在邢台市第三医院就诊的200例ESRD患者为观察组,分为轻中重度3个亚组,纳入100例志愿者为对照组。检测尿液miR-34a、血尿酸、血清尿素氮、血清肌酐,计算eGFR,记录观察组透析后1个月的周尿素清除指数(Kt/V)、周肌酐清除率(creatinine clearance,Ccr),并计算残余肾功能(residual renal function,RRF)。探究尿液miR-34a、血尿酸表达对预后的影响。结果 (1)对照组血清白蛋白、血红蛋白高于其它3组(F=44.315,P <0.001;F=94.867,P<0.001),对照组血清磷低于其它3组(F=17.589,P<0.001)。随着病情加重血清白蛋白、血红蛋白降低,血清磷升高。(2)随着病情加重,eGFR、Kt/V、Ccr、RRF下降(F=9573.09,P<0.001;F=27.499,P<0.001;F=240.636,P<0.001;F=1095.17,P<0.001),BUN、SCr升高(F=721.543,P<0.001;F=2170.64,P<0.001)。(3)观察组尿液miR-34a和血UA均高于对照组(χ~2=49.352,P<0.001;χ~2=341.151,P<0.001),随着病情加重,尿液miR-34a表达和血UA升高。(4)尿液miR-34a、血UA和eGFR、Kt/V、Ccr、RRF呈负相关(miR-34a:r=-0.193,P=0.001;r=-0.147,P=0.038;r=-0.192,P=0.007;r=-0.178,P=0.012。血UA:r=-0.175,P=0.002;r=-0.201,P=0.004;r=-0.183,P=0.010;r=-0.254,P<0.001),尿液miR-34a、血UA和BUN、SCr呈正相关性(miR-34a:r=0.125,P=0.030,;r=0.160,P=0.006。血UA:r=0.121,P=0.036;r=0.149,P=0.009)。(5)miR-34a、血尿酸高表达组与低表达组3年生存曲线差异有统计学意义(χ~2=4.647,P=0.031;χ~2=9.775,P=0.002)。结论尿液miR-34a、血尿酸水平与CAPD患者的肾功能、残余肾功能存在相关性,尿液miR-34a高表达和血尿酸高水平影响CAPD治疗的ESRD患者的预后。更多还原

【Abstract】 Objective To explore the relationship between the levels of urinary microRNA-34 a(miR-34 a) and serum uric acid(UA) and the renal function and prognosis in end stage renal disease(ESRD) patients undergoing continuous ambulatory peritoneal dialysis(CAPD) treatment. Methods A total of 200 cases of ESRD patients undergoing CAPD from January 2016 to October 2017 were assigned as the observation group and they were subdivided into mild, moderate and severe subgroups; a total of 100 volunteers were recruited as the control group. Urinary miR-34 a, serum uric acid, blood urea nitrogen and serum creatinine(SCr) were measured, and eGFR was calculated. The weekly urea clearance index(Kt/V) and weekly creatinine clearance rate(CCR) after CAPD for one month were recorded, and residual renal function(RRF) was calculated. The effects of urinary miR-34 a and serum UA on prognosis were then explored. Results(1)Hemoglobin and serum albumin were significantly higher in the control group than in the observation group(F=94.867 and 44.315 respectively; P<0.001), and serum phosphorus was significantly lower in the control group than in the observation group(F=17.589, P<0.001). Hemoglobin and serum albumin were significantly decreased and serum phosphorus was significantly increased along with aggravation of the disease(P<0.05).(2)e GFR, Kt/V, CCR and RRF decreased(F=9573.09, 27.499, 240.636 and 1095.17 respectively; P<0.001),and BUN and SCr increased(F=721.543 and 2170.64 respectively; P<0.001) along with aggravation of the disease.(3)Urinary mi R-34 a and serum UA were significantly higher in the observation group than in the control group(χ~2=49.352 and 341.151 respectively,P<0.001), and were increased along with aggravation of the disease.(4)Urinary mi R-34 a and serum UA were negatively correlated with e GFR, Kt/V, CCR and RRF(For mi R-34 a: r=-0.193,-0.147,-0.192 and-0.178 respectively; P=0.001, 0.038, 0.007 and 0.012 respectively. For UA: r=-0.175,-0.201,-0.183 and-0.254 respectively; P=0.002, 0.004, 0.010 and <0.001 respectively). Urinary mi R-34 a and serum UA were positively correlated with BUN and SCr(For mi R-34 a: r=0.125 and 0.160 respectively; P=0.030 and 0.006 respectively. For UA: r=0.121 and 0.149 respectively; P=0.036 and 0.009 respectively).(5)The 3-year survival curve was statistically different between patients with higher levels of urinary mi R-34 a and serum UA and those with lower levels of urinary mi R-34 a and serum UA(χ~2=4.647 and9.775 respectively; P=0.031 and 0.002 respectively). Conclusion Urinary mi R-34 a and serum UA were significantly correlated with renal function and RRF. Higher levels of urinary mi R-34 a and serum UA suggest the unfavorable prognosis in ESRD patients with CAPD.更多还原