中文摘要：

目的：探讨尿液microRNA-196a（miR-196a）能否作为预测局灶节段性肾小球硬化（FSGS）远期预后的生物标志物。方法：收集FSGS患者和正常对照的尿液和血浆标本,分析尿液和血浆miR-196a水平与FSGS活动性的关系。入选231例经肾活检确诊的FSGS,qRT-PCR方法检测尿液miR-196a水平,评估尿液miR-196a对FSGS预后的预测价值。结果：尿液miR-196a水平在活动性FSGS患者组显著高于肾脏疾病完全缓解组和正常对照组（P〈0.001）,血浆miR-196a水平在三组之间无明显差异,表明尿液miR-196a是一种主要来源于肾脏的生物标志物。231例随访患者中,43例进展为终末期肾病（ESRD）。发生ESRD的患者尿液miR-196a水平显著高于未发生ESRD的患者（P=0.025）。尿液miR-196a水平与蛋白尿和估算的肾小球滤过率（e GFR）相关,与肾间质纤维化评分存在相关性。随着尿液miR-196a水平增加,患者发生ESRD的风险增加。校正年龄、性别、蛋白尿、e GFR后尿液miR-196a升高仍是患者进展至ESRD的独立危险因素。结论：尿液miR-196a是FSGS患者发生ESRD的独立危险因素,可能成为预测FSGS远期预后的新型生物标志物。

英文摘要：

Objective： To investigate the association between urinary microRNA-196a（ miR-196a） and long-term outcome in patients with focal segmental glomerulosclerosis（ FSGS）. Methodology： Urinary and plasma miR-196 a were tested in patients with active FSGS（ FSGS-A）,FSGS in complete remission（ FSGS-CR） and normal controls（ NC）. 231 FSGS patients were then enrolled at the time of renal biopsy and urinary miR-196 a levels were measured by qRT-PCR. The relationship between urinary miR-196 a and long-term outcome of FSGS was analyzed. Results： Urinary miR-196 a levels were significantly increased in FSGS-A patients as compared with FSGS-CR patients and NCs（ P〈0. 001）. However,plasma miR-196 a levels showed no difference among the three groups,suggesting that the change of urinary miR-196 a was mainly kidney derived. Of the 231 patients,43 patients developed end-stage renal disease（ ESRD） during the follow-up period. Urinary miR-196 a levels were significantly higher in patients who progressed to ESRD than those not progressed to ESRD（ P = 0. 025）. Urinary miR-196 a was associated with proteinuria,e GFR,and interstitial fibrosis. Patients with higher urinary miR-196 a levels had a higher cumulative incidence of ESRD. Risk persisted after adjusting for age, sex,proteinuria,and eG FR. Conclusion： Urinary miR-196 a is an independent risk factor of ESRD, facilitating early identification of those who will subsequently develop ESRD.