Wilson 病患者 LncRNA Meg3 表达水平与肝纤维化指标的相关性分析

doi:10.12122/j.issn.1673-4254.2025.11.09

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (11): 2365-2374.doi: 10.12122/j.issn.1673-4254.2025.11.09

Wilson 病患者 LncRNA Meg3 表达水平与肝纤维化指标的相关性分析

花代平¹(), 宣巧玉¹, 孙兰婷¹, 于庆生², 王琴³, 王涛⁴, 马麒颜⁴, 杨文明¹^,⁵, 汪瀚¹^,⁵()

^1.安徽中医药大学第一附属医院，神经内科，安徽合肥 230031
^2.安徽中医药大学第一附属医院，普外科，安徽合肥 230031
^3.安徽中医药大学第一附属医院，超声科，安徽合肥 230031
^4.安徽中医药大学第一临床医学院，安徽合肥 230031
^5.新安医学教育部重点实验室//安徽中医药大学，安徽合肥 230038

收稿日期:2025-05-01 出版日期:2025-11-20 发布日期:2025-11-28
通讯作者: 汪瀚 E-mail:15655171331@163.com;neuwhah@126.com
作者简介:花代平，在读博士研究生，E-mail: 15655171331@163.com
基金资助:
国家自然科学基金区域创新发展联合基金项目(U22A20366);安徽省中医药科技攻关专项项目(202303a07020004);全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号);安徽省自然科学基金项目(2208085MH266);安徽省卫生健康科研项目(AHWJ2022b036)

LncRNA Meg3 expression level is negatively correlated with liver fibrosis severity in patients with Wilson disease

Daiping HUA¹(), Qiaoyu XUAN¹, Lanting SUN¹, Qingsheng YU², Qin WANG³, Tao WANG⁴, Qiyan MA⁴, Wenming YANG¹^,⁵, Han WANG¹^,⁵()

^1.Department of Neurology, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
^2.Department of General Surgery, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
^3.Department of Ultrasound, First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei 230031, China
^4.First Clinical Medical College of Anhui University of Chinese Medicine, Hefei 230031, China
^5.Key Laboratory of Xin'an Medicine, Ministry of Education, Anhui University of Chinese Medicine, Hefei 230038, China

Received:2025-05-01 Online:2025-11-20 Published:2025-11-28
Contact: Han WANG E-mail:15655171331@163.com;neuwhah@126.com
Supported by:
Regional Innovation and Development Joint Fund of National Natural Science Foundation of China(U22A20366)

摘要/Abstract

摘要：

目的探讨Wilson 病（WD）患者长链非编码 RNA 母系表达基因 3（LncRNA Meg3）基因表达水平与肝纤维化程度、Beclin-1、微管结合蛋白 1 轻链 3B（LC3B）的相关性。方法选取安徽中医药大学第一附属医院就诊的 WD 患者（WD 组）100 例和健康对照者（对照组）50 例，检测血小板计数（PLT）、透明质酸（HA）、层黏连蛋白（LN）、Ⅲ 型前胶原 N 端肽（PⅢNP）、Ⅳ 型胶原（C-Ⅳ）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST），计算肝纤维化血清无创伤诊断模型 AST 和 PLT 比率指数（APRI）评分以及肝纤维化-4指数（FIB-4）；RT-qPCR 检测外周血 LncRNA Meg3、Beclin-1、LC3B 表达；二维剪切波弹性成像（2D-SWE）检测肝脏硬度值（LSM）、剪切波速度（SWV），并依据LSM值进行2D-SWE肝纤维化分期。同时选取我院经肝活检诊断为 WD （WD 组）和术后病理诊断为肝血管瘤患者（HC组）各10例，术中取新鲜肝脏组织，采用苏木精-伊红（HE）、马松（Masson）和铜染色（罗丹宁法）观察肝组织病理学改变并进行肝纤维化分期；透射电镜观察肝组织超微结果；RT-qPCR 检测肝组织 LncRNA Meg3、Beclin-1、LC3B 表达。结果与对照组相比，WD组外周血LncRNA Meg3表达水平显著下降（P<0.01），AST、ALT、HA、LN、PⅢNP、C-Ⅳ、APRI、FIB-4、LSM、SWV水平升高（P<0.01）；LncRNA Meg3与LSM、SWV、APRI、FIB-4、Beclin-1、LC3B 呈负相关（P<0.05）；ROC曲线结果显示LncRNA Meg3对2D-SWE肝纤维化>F4期的诊断敏感度为92.9%，特异度为83.7%，AUC为0.902（95% CI：0.835~0.969），诊断效能显著优于APRI（AUC=0.746）和FIB-4（AUC=0.661）。2D-SWE肝纤维化分期与 LncRNA Meg3、Beclin-1、LC3B、APRI、FIB-4、HA、LN、C-Ⅳ表达水平差异有统计学意义（P<0.05）；WD组肝细胞核固缩、溶解，细胞轮廓消失坏死，胶原纤维显著增生，肝细胞胞质内大量砖红色铜颗粒沉积，以变性肝细胞为甚；电镜下自噬小体和自噬溶酶体数量增多。与HC组相比，WD组肝组织LncRNA Meg3表达水平低（P<0.05），Beclin-1、LC3B表达水平高（P<0.05），LncRNA Meg3表达水平与Beclin-1、LC3B表达水平呈负相关（P<0.05）。肝纤维化分期（S4期7例，S3期3 例）与LSM、SWV水平差异均有统计学意义（P<0.05）。结论 WD患者LncRNA Meg3表达水平显著下降，且与肝纤维化程度呈负相关，与自噬水平密切相关。

关键词: Wilson 病, 长链非编码 RNA 母系表达基因 3, 肝纤维化, 自噬

Abstract:

Objective To investigate the expression of the long non-coding RNA maternally expressed gene 3 (LncRNA Meg3) in patients with the Wilson disease (WD) and its correlation with the severity of liver fibrosis and autophagy-related markers. Methods A total of 100 WD patients and 50 healthy individuals were enrolled from the First Affiliated Hospital of Anhui University of Chinese Medicine. Serum biomarkers, including platelet count, hyaluronic acid (HA), laminin (LN), type III procollagen N-terminal peptide (PIIINP), type IV collagen (C‑IV), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), were measured, and the non-invasive indices APRI and FIB-4 were calculated. Peripheral blood levels of LncRNA Meg3, Beclin-1 and LC3B were detected using RT-qPCR, and liver stiffness (LSM) and shear wave velocity (SWV) were evaluated using two-dimensional shear wave elastography (2D-SWE). The liver tissues from 10 WD patients and 10 patients with hepatic hemangioma were examined using histochemical staining, transmission electron microscopy, and RT-qPCR. Results The expression level of LncRNA Meg3 was significantly lower, while the levels of AST, ALT, HA, LN, PIIINP, C‑IV, APRI, FIB-4, LSM and SWV were significantly higher in WD patients than in the healthy individuals (all P<0.01). LncRNA Meg3 was negatively correlated with LSM, SWV, APRI, FIB-4, Beclin-1 and LC3B (P<0.05). ROC analysis demonstrated that LncRNA Meg3 effectively discriminated >F4 stage fibrosis (AUC=0.902) with a sensitivity of 92.9% and a specificity of 83.7% at the optimal cut-off value, outperforming APRI (AUC=0.746) and FIB-4 (AUC=0.661). The liver tissues from WD patients exhibited characteristic histopathological changes and lowered expression of LncRNA Meg3, which was negatively correlated with Beclin-1 and LC3B expressions (P<0.05). Liver fibrosis staging (7 S4 cases and 3 S3 cases) was significantly associated with LSM and SWV levels (P<0.05). Conclusion The expression level of LncRNA Meg3 is significantly decreased in WD patients, which is negatively correlated with the severity of liver fibrosis and closely related to the level of autophagy.

Key words: Wilson disease, LncRNA Meg3, liver fibrosis, autophagy

花代平, 宣巧玉, 孙兰婷, 于庆生, 王琴, 王涛, 马麒颜, 杨文明, 汪瀚. Wilson 病患者 LncRNA Meg3 表达水平与肝纤维化指标的相关性分析[J]. 南方医科大学学报, 2025, 45(11): 2365-2374.

Daiping HUA, Qiaoyu XUAN, Lanting SUN, Qingsheng YU, Qin WANG, Tao WANG, Qiyan MA, Wenming YANG, Han WANG. LncRNA Meg3 expression level is negatively correlated with liver fibrosis severity in patients with Wilson disease[J]. Journal of Southern Medical University, 2025, 45(11): 2365-2374.

图/表 11

表1 WD组与对照组基线资料和观察指标分析

Tab.1 Baseline data and observation indexes in WD and control groups

Variable	WD group (n=100)	Control group (n=50)	χ² /z/t	P
Male [n (%)]	61 (61.00)	29 (58.00)	0.125	0.724
Age (year)	26.00 (22.00, 35.00)	25.00 (23.00, 31.00)	-0.647	0.518
BMI (kg/m²)	21.62 (20.21, 22.69)	21.05 (20.28, 22.64)	-0.451	0.652
ALT (U/L)	30.00 (20.45, 54.20)	16.70 (14.40, 22.40)	-5.132	<0.001
AST (U/L)	30.40 (22.15, 42.15)	19.00 (16.40, 22.60)	-6.127	<0.001
APRI	0.53 (0.33, 0.78)	0.32 (0.28, 0.39)	-5.482	<0.001
FIB-4	0.98 (0.56, 1.44)	0.52 (0.39, 0.58)	-5.753	<0.001
HA (ng/mL)	108.07 (66.65, 175.39)	67.47 (54.74, 83.28)	-5.116	<0.001
LN (ng/mL)	112.12 (84.56, 160.35)	80.77 (76.59, 90.46)	-4.956	<0.001
PⅢNP (ng/mL)	16.20 (10.01, 26.36)	9.62 (7.90, 10.33)	-5.759	<0.001
C-Ⅳ (ng/mL)	72.31 (53.44, 100.65)	48.70 (38.52, 59.83)	-5.512	<0.001
LSM (kPa)	10.17 (7.93, 13.82)	5.20 (3.81, 5.77)	-9.217	<0.001
SWV (m/s)	1.85 (1.62, 2.11)	1.26 (1.09, 1.32)	-9.603	<0.001
LncRNA Meg3	0.59 (0.11, 1.42)	1.20 (0.56, 1.84)	3.700	<0.001
Beclin-1	1.18 (0.72, 1.61)	1.11 (0.95, 1.30)	-0.339	0.735
LC3B	1.35 (0.54, 2.02)	1.17 (0.85, 1.45)	-0.797	0.425

图1 研究流程图

Fig.1 Flow chart of the study.

图2 WD 患者外周血 LncRNA Meg3 与肝纤维化指标、Beclin-1、LC3B 的相关性分析散点图

Fig.2 Scatter plot diagram showing the correlation of LncRNA Meg3 in peripheral blood of WD patients with liver fibrosis indexes and Beclin-1 and LC3B. LncRNA Meg3 in peripheral blood was negatively correlated with HA (A), LN (B), PⅢNP (C), C-Ⅳ (D), APRI (E), FIB-4 (F), LSM (G), SWV (H), Beclin-1 (I) and LC3B (J).

表2 WD 患者外周血 LncRNA Meg3 与连续变量的多重线性回归分析

Tab.2 Multiple linear regression analysis of peripheral blood LncRNA Meg3 and the continuous variables in WD patients

Variable	β	t	P
HA	-0.140	-1.376	0.172
LN	-0.072	-0.710	0.480
PⅢNP	-0.032	-0.308	0.758
C-Ⅳ	-0.125	-1.240	0.218
APRI	-0.231	-2.340	0.021
FIB-4	-0.276	-2.566	0.012
LSM	-0.569	-6.441	<0.001
SWV	0.572	-6.500	<0.001
Beclin-1	-0.402	-4.321	<0.001
LC3B	-0.278	-2.821	0.006

图3 WD患者外周血 LncRNA Meg3、FIB-4、APRI 的 ROC曲线

Fig.3 ROC curves for peripheral blood LncRNA Meg3, FIB-4, and APRI in WD patients. The AUC for LncRNA Meg3 was 0.902 (95% CI: 0.835-0.969), significantly higher than that of FIB-4 (AUC=0.661) and APRI (AUC=0.746).

图4 WD 患者 2D-SWE 肝纤维化分期与观察指标分析箱式图

Fig.4 2D-SWE liver fibrosis stage and observation index analysis box plot of WD patients.Histograms are shown for HA (A), LN (B), PⅢNP (C), C-Ⅳ (D), APRI (E), FIB-4 (F), LncRNA Meg3 (G), Beclin-1 (H) and LC3B (I) for different 2D-SWE liver fibrosis stages. *P<0.05, **P<0.01.

图5 WD 组与 HC 组 HE 染色、Masson染色、铜染色对比

Fig.5 HE (A), Masson (B) and copper staining (C) of the liver tissues from WD and healthy control (HC) groups (scale bar=50 μm).

图6 WD 组与HC组透射电镜对比

Fig.6 Transmission electron microscopy of the liver tissues in WD and HC groups (A: original magnification: ×10 000; B: ×25 000). Red arrows indicate the autophagosomes.

图 7 WD 组与 HC 组肝组织 LncRNA Meg3、Beclin-1、LC3B 表达水平分析箱式图

Fig.7 Box plots of the expression levels of LncRNA Meg3 (A), Beclin-1 (B) and LC3B (C) in the liver tissues in WD and HC groups. *P<0.05.

图 8 WD 组肝组织 LncRNA Meg3 与 Beclin-1、LC3B 的相关性分析散点图

Fig.8 Scatter plots for correlation analysis of LncRNA Meg3 with Beclin-1 (A) and LC3B (B) in the liver tissue of WD group.

图9 WD 组肝组织肝纤维化分期与LSM、SWV水平分析箱式图

Fig.9 Box plot of LSM (A) and SWV (B) levels in WD patients with different liver fibrosis stages. *P<0.05

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Wilson 病患者 LncRNA Meg3 表达水平与肝纤维化指标的相关性分析

LncRNA Meg3 expression level is negatively correlated with liver fibrosis severity in patients with Wilson disease

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