Relationship Between Erythropoietin Content In Peripheral Blood And Urine And Renal Fibrosis In Patients With Chronic Kidney Disease

Objective:We detect the contents and changes of Erythropoietin,transforming growth factor-beta1 and ?-smooth muscle actin in peripheral blood and urine of Chronic kidney disease patients,to investigate the relationship between EPO and TGF-?1,?-SMA and their effects on renal fibrosis.Method:Hospitalized patients who underwent renal biopsy in the Department of Nephrology,First Hospital of Jilin University were selected from May 2019 to December 2019.Among them,78 patients were diagnosed with chronic kidney disease.According to the 2009 IgA nephropathy Oxford classification,the renal tubular atrophy and intermal fibrosis were divided into three groups: 29 cases in the T0 group(mild fibrosis group),36 cases in the T1group(moderate fibrosis group),and 13 cases in the T2 group(severe fibrosis group).The20 healthy controls were all from the physical examination center of the first hospital of Jilin university.The general clinical data(the patient's age,gender,weight,previous medical history and so on)and clinical indicators(blood creatinine,urea nitrogen,serum albumin,peripheral blood red blood cell,hemoglobin)were collected and sorted out.The content of EPO in peripheral blood and urine was detected by chemiluminescence immunoassay,and the content of TGF-?1 and ?-SMA in peripheral blood and urine of each group was detected by enzyme-linked immunosorbent assay method.Analyze the content of EPO,TGF-?1 and?-SMA in peripheral blood and urine of patients with renal fibrosis of different degrees and the relationship with various related factors,and explore the effect of EPO on renal tissue fibrosis and its protective effect on kidney.Results:(1)The contents of EPO in peripheral blood of T0 group,T1 group,T2 group were respectively 12.63�7.98 mIU/mL,15.20�10.34 mIU/mL,10.76�5.75 mIU/mL,and the contents of EPO in urine were respectively 1.47�1.13 mIU/mL,2.16�1.73 mIU/mL,1.37�0.83 mIU/mL;the content of EPO in peripheral blood of the healthy control group was10.30�5.10 mIU/mL,and the content of EPO in urine was 1.28 � 0.56 mIU/mL;Compared with the healthy control group,the content of EPO in peripheral blood and urine of CKD patients with renal biopsy was higher,and the difference was statistically significant(P<0.001).Among CKD patients with renal biopsy,the EPO content of T1 group was higher than that of T0 group and T2 group,the difference was statistically significant(P <0.001).Correlation between the content of EPO in peripheral blood and urine: correlation analysis showed there was a positive correlation between EPO content in peripheral blood and that in urine.CKD patients(r=0.898,P<0.001),and normal control group(r=0.543,P<0.001),and the results indicated that the EPO content of blood and urine were parallel change.(2)The content of ?-SMA in peripheral blood of the T0 group,T1 group and T2 group were respectively 139.49�55.81 ng/L ? 152.90�186.2 ng/L ?165.03�28.46 ng/L,and the content of ?-SMA in urine were respectively 62.19�22.91 ng/L ? 91.50�50.93 ng/L ?138.28�107.12 ng/L.The content of ?-SMA in peripheral blood of the healthy control group was 125.30�101.05 ng/L,and the content of ?-SMA in urine was 31.06�10.88 ng/L.Compared with the healthy control group,the contents of ?-SMA in peripheral blood and urine of renal biopsy CKD patients were increased,and the difference was statistically significant(P<0.05).With the aggravation of the degree of renal tissue fibrosis,?-SMA in peripheral blood and urine gradually increased,and the difference was statistically significant(P<0.05).(3)The content of TGF-?1 in peripheral blood of the T0 group,T1 group and T2 group were respectively 10.05�4.87 ?g/L?12.56�7.85 ?g/L?22.91�9.32 ?g/L,and the content of TGF-?1 in urine were respectively 4.74�2.24 ?g/L?7.01�4.27 ?g/L?9.28�10.21 ?g/L.The content of TGF-?1 in peripheral blood of the healthy control group was 6.91�4.45 ?g/L,and the content of TGF-?1 in urine was 3.14�1.42 ?g/L.Compared with the healthy control group,the contents of TGF-?1 in peripheral blood and urine of renal biopsy CKD patients were increased,and the difference was statistically significant(P<0.05).With the aggravation of the degree of renal tissue fibrosis,TGF-?1 in peripheral blood and urine gradually increased,and the difference was statistically significant(P<0.05).(4)Correlation analysis showed that the content of EPO in peripheral blood of CKD patients with renal biopsy was weakly negatively correlated with peripheral blood ?-SMA,and moderately negatively correlated with peripheral blood TGF-?1.The content of EPO in urine has no correlation with ?-SMA and TGF-?1 in urine.(5)Compared with the healthy control group,the levels of BUN and Scr in CKD patients were significantly increased and the levels of eGFR were significantly reduced,and the difference was statistically significant(P <0.05).There were significant differences in Scr,BUN and eGFR(P <0.001)among the three groups of renal biopsy CKD patients,and HB,RBC and ALB were not statistically significant(P> 0.05).(6)Pearson correlation analysis showed that the content of EPO in peripheral blood and urine of CKD patients with renal biopsy was not related to Scr,BUN,eGFR,HB,RBC and ALB.Conclusions:(1)The content of EPO in the peripheral blood and urine of the CKD group is higher than that of the healthy group.In mild and moderate fibrosis,the EPO level is positively correlated with the degree of renal tissue fibrosis.In severe fibrosis,In severe fibrosis,the EPO level is relatively mild and moderately decreased due to the increase in renal tissue damage.(2)The degree of renal tissue fibrosis was positively correlated with the levels of TGF-?1??-SMA.(3)The content of EPO in CKD patients was negatively correlated with the content of TGF-?1??-SMA,EPO may play a role in delaying the progression of CKD fibrosis by reducing the levels of TGF-?1??-SMA in CKD patients.