Abstract 【Objective】This study aims to investigate the diagnostic value of exosomal miRNA-21 in early fibrosis of lupus nephritis (LN). 【Methods】A total of 54 LN patients admitted to our nephrology department were enrolled. Based on the chronic fibrosis index (CI) of the kidneys, patients were divided into the low CI group (CI<2 scores, n=20), the moderate CI group (2 scores≤CI≤4 scores, n=27), and the high CI group (CI>4 scores, n=7). The level of miRNA-21 in urine samples from all patients were measured, and the differential expression of miRNA-21 in different degrees of renal fibrosis was analyzed. Pearson correlation analysis was performed to assess the relationship between miRNA-21 and clinical indicators. The diagnostic value of miRNA-21 in early renal fibrosis of LN was evaluated using receiver operating characteristic (ROC) curve analysis. 【Results】The high CI group had significantly lower estimated glomerular filtration rate (eGFR) level than that of the low CI and moderate CI groups (P<0.05). While the 24-hour urinary protein and miRNA-21 level in the high CI group were significantly higher than that in the low CI and moderate CI groups. The differences were statistically significant (P<0.05). The moderate CI group had lower eGFR level than the low CI group (P<0.05) and higher 24-hour urinary protein and miRNA-21 level than the low CI group (P<0.05).Pearson correlation analysis revealed a significant positive correlation of exosomal miRNA-21 with SLEDAI score, anti-dsDNA antibodies, blood urea nitrogen (BUN), serum creatinine (Scr), CI scores, and urinary protein (P<0.05). However, a significant negative correlation was observed between miRNA-21 and eGFR (P<0.05).Exosomal miRNA-21 was identified as an independent factor affecting early renal fibrosis in LN, with an odds ratio (OR) (95%CI) of 2.93 (1.18-5.36).The area under the curve (AUC) for exosomal miRNA-21 in identifying early fibrosis of LN was 0.85, with the optimal cutoff value at 5.76. 【Conclusion】Exosomal miRNA-21 shows potential value as a diagnostic marker for early renal fibrosis in LN patients.
[1] SOLÉ C,MOLINé T,VIDAL M,et al. An exosomal urinary miRNA signature for early diagnosis of renal fibrosis in lupus nephritis[J].Cells,2019,8(8):773. [2] BOOR P,OSTENDORF T,FLOEGE J. Renal fibrosis:Novel insights into mechanisms and therapeutic targets [J].Nat Rev Nephrol,2010,6(11):643-656. [3] CHUNG A C,YU X,LAN H.MicroRNA and nephmpathy:emerging concepts[J].Int J Nephml Renovasc Dis,2013,6:169-179. [4] 李丹,冯爱桥,包佩玲,等. 微小RNA-29c在红斑狼疮性肾炎早期肾纤维化中的临床意义[J].临床内科杂志,2017,34(5):332-334. [5] 中华医学会风湿病学分会. 系统性红斑狼疮诊断和治疗指南[J].中华风湿病学杂志,2010,15(3):342-346. [6] 张运津,章桂娇,徐青青,等. miRNA-374a在狼疮肾炎患者血清中的表达及其意义[J].实验与检验医学,2016,34(3):274-276. [7] 徐雪梅,田春雨,喇孝瑾,等.十子代平方对糖尿病大鼠肾脏 TGF-β、PTEN及血浆miRNA-21表达的影响[J].中药材,2017,40(6):1443-1447. [8] 许薇,姚少侠,苟小林. 血清miRNA-21和miRNA-192表达与糖尿病肾病的相关性研究[J].河北医科大学学报,2019,40(12):1460-1464. [9] BAO H,HU S,ZHANG C,et al.Inhibition of miRNA-21 prevents fibrogenic activation in podocytes and tubular cells in IgA nephropathy[J].Biochem Biophys Res Commun,2014,444(4):455-460. [10] LU X,FAN Q,XU L,et al.Ursolic acid attenuates diabetic mesangial cell injury through the up-regulation of autophagy via miRNA-21/PTEN/Ak/mTOR suppression[J].PLoS One,2015,10(2):e0117400. [11] 钟瑜,韩文伦,朱芸芸,等.纤维化肾小管上皮细胞miRNA-21表达情况研究[J].中国生化药物杂志,2017,37 (3):44-47.
2023, Vol. 40 
