不同血液净化方法对维持性血液透析尿毒症动脉粥样硬化患者血清microRNA-144和microRNA-155水平的影响及其临床意义

摘要 目的：探讨不同血液净化方法对维持性血液透析（MHD）尿毒症动脉粥样硬化患者血清microRNA-144和microRNA-155水平的影响及其临床意义。方法：选取2019年6月~2020年6月川北医学院附属医院收治的98例MHD尿毒症动脉粥样硬化患者为研究组，另选取98例同期本院体检健康的志愿者为健康对照组，比较两组血清microRNA-144和microRNA-155、血清炎症因子白细胞介素-6（IL-6）、单核细胞趋化蛋白-1（MCP-1）、超敏C反应蛋白（hs-CRP）]水平。采用Pearson分析法分析血清microRNA-144、microRNA-155水平与MHD尿毒症动脉粥样硬化患者内膜中层厚度（IMT）值、斑块面积及血清炎症因子的相关性。采用多因素Logistic回归分析MHD尿毒症动脉粥样硬化患者IMT增厚的影响因素。将研究组按随机数字表法分为血液透析滤过组和血液灌流组，各49例。血液透析滤过组给予血液透析滤过联合血液透析治疗，血液灌流组给予血液灌流联合血液透析治疗。比较两组血清microRNA-144和microRNA-155、血清炎症因子水平、IMT值和斑块面积。结果：研究组血清microRNA-144、microRNA-155、IL-6、MCP-1、hs-CRP水平明显高于健康对照组（P<0.05）；Pearson相关性结果显示，血清microRNA-144、microRNA-155均与MHD尿毒症动脉粥样硬化患者IMT值、斑块面积及IL-6、MCP-1、hs-CRP均呈正相关（P<0.05）；多因素Logistic回归分析结果显示，血清microRNA-144、microRNA-155、IL-6、MCP-1、hs-CRP水平均是导致MHD尿毒症动脉粥样硬化患者IMT增厚的危险因素（P<0.05）。治疗后，血液灌流组血清microRNA-144和microRNA-155水平均明显低于血液透析滤过组（P<0.05），IL-6、MCP-1、hs-CRP水平均明显低于血液透析滤过组（P<0.05），IMT值和斑块面积均明显低于血液透析滤过组（P<0.05）。结论：血清microRNA-144、microRNA-155水平与IMT值、斑块面积及IL-6、MCP-1、hs-CRP水平呈正相关，均是MHD尿毒症动脉粥样硬化患者IMT增厚的危险因素。血液灌流联合血液透析治疗可减轻机体炎症反应，延缓动脉粥样硬化进程，可能与下调患者血清microRNA-144、microRNA-155水平有关。

Effect of Different Methods of Blood Purification on Serum Levels of microRNA-144 and microRNA-155 in Uremic Atherosclerosis Patients on Maintenance Hemodialysis and Its Clinical Significance

ABSTRACT Objective: To investigate effect of different methods of blood purification on serum levels of microRNA-144 and microRNA-155 in uremic atherosclerosis patients on maintenance hemodialysis and its clinical significance (MHD). Methods: A total of 98 MHD uremic atherosclerotic patients who were admitted to Affiliated Hospital of North Sichuan Medical College from June 2019 to June 2020 were selected as the study group, and another 98 volunteers who were healthy by physical examination during the same period were selected as the healthy control group, The levels of serum microRNA-144, microRNA-155 and serum inflammatory factors interleukin-6 (IL-6), monocyte chemochemic protein-1(MCP-1), and hypersensitive C-reactive protein (HS-CRP)] were compared between the two groups. Pearson analysis was used to analyze the correlation between the levels of serum microRNA-144 and microRNA-155 and the values of intima-media thickness (IMT), plaque area, and serum inflammatory factors in MHD uremic atherosclerosis patients. Multivariate logistic regression was used to analyze the influence factors of IMT thickening in MHD uremic atherosclerosis patients. The study group was divided into hemodiafiltration group and hemoperfusion group according to the random number table method, 49 cases in each group. The Hemodiafiltration group was given hemodiafiltration combined with hemodialysis, and hemoperfusion group was given hemoperfusion combined with hemodialysis. The levels of serum microRNA-144, microRNA-155, IL-6, MCP-1, hS-CRP, IMT values and plaque area were compared between the two groups. Results: The levels of serum microRNA-144, microRNA-155, IL-6, MCP-1 and hS-CRP in the study group were significantly higher than those in the healthy control group(P<0.05). Pearson correlation results showed that microRNA-144 and microRNA-155 were positively correlated with IMT value, plaque area, IL-6, MCP-1 and hS-CRP in MHD uremic atherosclerosis patients (P<0.05). Multivariate logistic regression analysis showed that the level of serum microRNA-144, microRNA-155, IL-6, MCP-1 and hs CRP were risk factors for IMT thickening in MHD uremic atherosclerosis patients(P<0.05). After treatment, the levels of serum microRNA-144 and microRNA-155 in hemoperfusion group were significantly lower than those in hemodialafiltration group(P<0.05), and the levels of IL-6, MCP-1 and hS-CRP were significantly lower than those in hemodialafiltration group (P<0.05). IMT value and plaque area were significantly lower than those in hemodialafiltration group(P<0.05). Conclusion: The level of serum microRNA-144 and microRNA-155 are positively correlated with IMT value, plaque area, the level of IL-6, MCP-1 and hs CRP, all are risk factors of IMT thickening in MHD uremic atherosclerosis patients. Hemoperfusion combined with Hemodialysis treatment can reduce the body''s inflammatory response and delay the progression of atherosclerosis, may be related to the down-regulation of the level of serum microRNA-144, microRNA-155 in patients.