【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(χ2=49.352，P＜0.001；χ2=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)。⑤miR-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(χ2=4.647，P=0.031；χ2=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。
【Abstract】Objective To explore the relationship between the levels of urinary microRNA-34a (miR-34a) 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- 34a, 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-34a and serum UA on prognosis were then explored. Results ①Hemoglobin 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). ②eGFR, 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. ③Urinary miR-34a and serum UA were significantly higher in the observation group than in the control group (χ2=49.352 and 341.151 respectively，P＜0.001), and were increased along with aggravation of the disease. ④Urinary miR-34a and serum UA were negatively correlated with eGFR, Kt/V, CCR and RRF (For miR-34a: 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 miR-34a and serum UA were positively correlated with BUN and SCr (For miR-34a: 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). ⑤The 3-year survival curve was statistically different between patients with higher levels of urinary miR-34a and serum UA and those with lower levels of urinary miR-34a and serum UA (χ2= 4.647 and 9.775 respectively; P=0.031 and 0.002 respectively). Conclusion Urinary miR-34a and serum UA were significantly
correlated with renal function and RRF. Higher levels of urinary miR-34a and serum UA suggest the unfavorable prognosis in ESRD patients with CAPD.
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