昆明医科大学学报2026，Vol.47Issue(8)：81-89,9.DOI:10.12259/j.issn.2095-610X.S20260808
外周血单个核细胞miR-155、miR-146a联合预测尿毒症维持性血液透析患者预后不良风险的价值
Combined Predictive Value of miR-155 and miR-146a in Peripheral Blood Mononuclear Cells for Assessing Poor Prognosis Risk in Patients with Uremia Undergoing Maintenance Hemodialysis
摘要
Abstract
Objective To explore the value of microRNA-155(miR-155)and microRNA-146a(miR-146a)in peripheral blood mononuclear cells(PBMC)in combined prediction of poor prognosis risk in uremic patients undergoing maintenance hemodialysis(MHD).Methods A prospective study enrolled 214 uremic patients from January 2021 to November 2023 as research subjects.All patients received MHD treatment with 1-year follow-up,and prognostic outcomes were recorded.Levels of miR-155 and miR-146a in PBMC before the first hemodialysis were detected in all patients.PBMC miR-155 and miR-146a levels were compared between patients with different prognoses.Using the median levels as cutoff values,patients were stratified into high miR-155/low miR-155 and high miR-146a/low miR-146a groups,which were further divided into four subgroups:low miR-155/low miR-146a(Q1),low miR-155/high miR-146a(Q2),high miR-155/low miR-146a(Q3),and high miR-155/high miR-146a(Q4).Clinical data and cumulative incidence of poor prognosis were compared among the four groups.Logistic regression was used to analyze the effects of miR-155 and miR-146a in PBMC on poor prognosis and their interactive efficacy.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of PBMC miR-155 and miR-146a for poor prognosis.Results Levels of miR-155 and miR-146a in PBMC were higher in patients with poor prognosis compared to those with good prognosis(P＜0.05).Significant differences were observed among the four groups regarding systolic blood pressure(SBP),diastolic blood pressure(DBP),C-reactive protein(CRP),neutrophil-to-lymphocyte ratio(NLR),intact parathyroid hormone(iPTH),and calcium-phosphorus product(P＜0.05).Group Q4 had higher SBP,DBP,CRP,NLR,iPTH,and calcium-phosphorus product compared to Q1,Q2,and Q3 groups,while Q2 and Q3 groups were higher than Q1(P＜0.05).CRP and NLR in Q3 were higher than in Q2(P＜0.05).The cumulative incidence of poor prognosis in Q4 was 51.43％,significantly higher than Q1(9.09％),Q2(30.00％),and Q3(25.49％),with Q2 and Q3 higher than Q1(P＜0.05).Lasso-Logistic regression analysis showed that after adjusting for confounding factors,the odds ratios(OR)for poor prognosis in Q2,Q3,and Q4 compared to Q1 were 2.397,2.735,and 5.033,respectively.Interaction analysis showed that the relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(S)for miR-155 and miR-146a were 0.901,0.179,and 1.288,respectively,indicating synergistic enhancement of poor prognosis risk with high miR-155 and high miR-146a(P＜0.05).ROC analysis demonstrated that the area under the curve(AUC)for combined prediction of poor prognosis using both miR-155 and miR-146a was 0.870,superior to individual predictions(Z=2.240,2.057;P=0.025,0.040).Conclusion Both miR-155 and miR-146a in PBMC are independent factors influencing poor prognosis in uremic patients undergoing MHD.These two microRNAs exhibit positive interactive effects on poor prognosis risk,and their combined detection has certain predictive value for poor prognosis.关键词
PBMC/miR-155/miR-146a/尿毒症/维持性血液透析/预后/预测Key words
PBMC/miR-155/miR-146a/Uremia/Maintenance hemodialysis/Prognosis/Prediction分类
医药卫生引用本文复制引用
王晓健,刘俊平,张迪,郭谦..外周血单个核细胞miR-155、miR-146a联合预测尿毒症维持性血液透析患者预后不良风险的价值[J].昆明医科大学学报,2026,47(8):81-89,9.基金项目
山西省卫生健康委科研基金(2022715) （2022715）
