中性粒细胞与淋巴细胞比率与高血压伴高同型半胱氨酸血症肾损伤的关系

The relationship between the neutrophil-to-lymphocyte ratio and renal injury in patients with hypertension with hyperhomocysteinemia

目的探讨中性粒细胞和淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)在高血压合并高同型半胱氨酸血症(hypertension with hyperhomocysteinemia,HWH)患者中的表达水平,评估NLR在HWH患者肾损伤中的临床价值。方法回顾性分析2017年1月-2020年12月在榆林市第二医院心血管内科住院并确诊为HWH的242例患者的临床资料。根据肾损伤定义,将242例患者分为肾损伤组(112例)和非肾损伤组(130例)。收集所有患者的临床资料,运用统计学方法比较两组患者的生化指标和血液学参数的差异,并分析HWH患者肾损伤的相关影响因素。结果HWH肾损伤组年龄、白细胞(white blood cell,WBC)计数、超敏C反应蛋白、β_(2)-微球蛋白、血清肌酐、同型半胱氨酸和NLR水平显著高于非肾损伤组,红细胞(red blood cell,RBC)计数、血红蛋白水平低于非肾损伤组,差异有统计学意义(P<0.05);NLR与血清肌酐和β_(2)-微球蛋白成正相关,差异有统计学意义(r值分别为0.562、0.462,P<0.05)。多因素logistic回归结果表明,NLR、β_(2)-微球蛋白和同型半胱氨酸水平升高均是HWH肾损伤的独立危险因素。NLR、β_(2)-微球蛋白和同型半胱氨酸三者联合诊断HWH肾损伤的敏感性、特异度和曲线下面积分别为89.3%、65.4%和0.84。结论NLR水平可反映肾损伤的严重程度,NLR升高是HWH肾损伤的独立危险因素。多指标联合诊断可提高HWH肾损伤检测的准确度,有助于HWH肾损伤的诊断。

Objective To determine the neutrophil-to-lymphocyte ratio(NLR)in patients with hypertension with hyperhomocysteinemia(HWH),and to evaluate the clinical value of the NLR in HWH patients with renal injuries.Methods A retrospective analysis was performed on the clinical data of 242 patients admitted to the Cardiovascular Department of Yulin Second Hospital from January 2017 to December 2020 who were diagnosed with HWH.According to the definition of renal injury,the patients were divided into renal injury(n=112)and non-renal injury groups(n=130).The clinical data of all patients were collected,and the biochemical indices and hematologic parameters of all patients were evaluated usingstatistical methods.The factors influencing renal injury in HWH patients were analyzed.Results Age,the white blood cell count,NLR,and the high-sensitivity C-reactive protein,β_(2)-microglobulin,serum creatinine,and homocysteine(Hcy)levels were significantly higher in the renal injury group than the non-renal injury group,while the red blood cell count and hemoglobin concentration were lower;the differences were statistically significant(P<0.05).The NLR was positively correlated with serum creatinine andβ_(2)-microglobulin levels(r=0.562and 0.462,respectively;P<0.05).Multivariate logistic regression showed that the increase in the NLR,andβ_(2)-microglobulin and Hcy levels were independent risk factors for renal injury in patients with HWH.The sensitivity,specificity,and area under the curve when combining the NLR,andβ_(2)-microglobulin and Hcy levels in the diagnosis of patients with HWH and renal injury were 89.3%,65.4%and 0.84,respectively.Conclu‐sion The NLR reflects the severity of renal injury in patients with HWH.The increase in NLR is an independent risk factor for renal injury in patients with HWH.Use of multiple laboratory indices improves the accuracy of detecting renal injury and facilitate the diagnosis of renal injury in patients with HWH.