2021 年第 10 期 第 16 卷

血清微小RNA-499和鸢尾素水平与维持性血液透析患者心血管事件发生的关系

The relationship between serum microRNA-499, irisin levels and cardiovascular events in maintenance hemodialysis patients

作者：王涛白运焕王涵邓娜孙玲

英文作者：Wang Tao Bai Yunhuan Wang Han Deng Na Sun Ling

单位：江苏省徐州市中心医院肾内科221000

英文单位：Department of Nephrology Xuzhou Central Hospital Jiangsu Province Xuzhou 221000 China

关键词：终末期肾病；维持性血液透析；心血管事件；微小RNA-499；鸢尾素

英文关键词：End-stagerenaldisease;Maintenancehemodialysis;Cardiovascularevents;MicroRNA-499;Irisin

• 摘要：

• 目的  探讨血清微小RNA(miR)-499和鸢尾素水平与维持性血液透析(MHD)患者发生心血管事件(CVE)的关系。方法 选取2017年1月至2020年1月江苏省徐州市中心医院收治的196例接受MHD治疗的患者作为观察组，根据6个月后CVE发生情况分为CVE组(74例)和无CVE组(122例)，另选取同期60名体检健康者为对照组，对比各组血清miR-499、鸢尾素水平，多因素Logistic回归方法分析MHD患者发生CVE的影响因素，受试者工作特征曲线分析血清miR-499、鸢尾素水平对MHD患者发生CVE的预测价值。结果 CVE组年龄、基线低密度脂蛋白胆固醇、甲状旁腺激素、血钙水平明显大于/高于无CVE组，基线收缩压、高密度脂蛋白胆固醇、总蛋白水平明显低于无CVE组，差异均有统计学意义(均P＜0.05)。对照组、无CVE组、CVE组血清miR-499水平逐渐提升［1.04(0.81,1.27)、1.55(1.14,1.78)、2.76(2.37,3.18)］，鸢尾素水平逐渐降低［356.25(280.99,429.81)、69.20(63.26,74.74)、49.02(42.00,56.41)μg/L］，两两比较差异均有统计学意义(均P＜0.05)。多因素Logistic回归分析结果 显示，基线低密度脂蛋白胆固醇、基线甲状旁腺激素、基线血钙、miR-499为MHD患者发生CVE的独立危险因素，鸢尾素为独立保护因素(均P＜0.05)。miR-499联合鸢尾素预测MHD患者发生CVE的敏感度和特异度高于miR-499、鸢尾素单独预测。结论 MHD患者血清miR-499水平明显提升，鸢尾素水平明显降低，与CVE发生密切相关。血清miR-499和鸢尾素水平联合检测可提升对MHD患者发生CVE的预测价值。

• Objective To investigate the relationship between serum microRNA-499(miR-499), irisin levels and cardiovascular events(CVE) in maintenance hemodialysis(MHD) patients. Methods From January 2017 to January 2020, 196 patients who received MHD treatment in Xuzhou Central Hospital, Jiangsu Province were selected as the observation group. According to the occurrence of CVE after 6 months, they were divided into CVE group(74 cases) and non-CVE group(122 cases), and another 60 healthy persons undergoing physical examination during the same period were selected as the control group. The serum miR-499 and irisin levels were compared among the groups. Multivariate Logistic regression method was used to analyze the influencing factors of CVE in MHD patients. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of serum miR-499 and irisin levels for CVE occurrence in MHD patients. Results The age, baseline low-density lipoprotein cholesterol, parathyroid hormone and serum calcium levels of CVE group were significantly older/higher than those of non-CVE group, and the baseline systolic blood pressure, high-density lipoprotein cholesterol and total protein levels of CVE group were significantly lower than those of non-CVE group(all P<0.05). The serum miR-499 levels in control group, non-CVE group and CVE group gradually increased［1.04(0.81,1.27), 1.55(1.14,1.78), 2.76(2.37,3.18)］, and irisin levels gradually decreased ［356.25(280.99,429.81), 69.20(63.26,74.74), 49.02(42.00,56.41) μg/L］, and the differences between each two groups were statistically significant(all P<0.05). Multivariate Logistic regression analysis showed that baseline low-density lipoprotein cholesterol, baseline parathyroid hormone, baseline serum calcium and miR-499 were independent risk factors for CVE in MHD patients, and irisin was an independent protective factor(all P<0.05). The sensitivity and specificity of miR-499 combined with irisin in predicting CVE in MHD patients were higher than those of miR-499 and irisin alone. Conclusions  The serum miR-499 level in MHD patients significantly increases, and the irisin level significantly decreases, which are closely related to the occurrence of CVE. Combined detection of the two indexes can improve the predictive value of CVE in MHD patients.