微炎症指标联合NLR预测终末期维持性血液透析患者预后价值探讨

Prognostic value of microinflammatory index combined with NLR in patients with end-stage maintenance hemodialysis

目的研究微炎症指标联合中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)预测终末期维持性血液透析(maintenance hemodialysis,MHD)患者预后价值。方法选取2018年2月~2021年2月合肥市第二人民医院终末期MHD患者110例,检测微炎症指标[白细胞介素-6(interleukin-6,IL-6)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血清淀粉样蛋白(serum amyloid protein,SAA)]及NLR,并根据1年内病死情况分为死亡组(n=23)与生存组(n=87)。比较两组一般资料及微炎症指标、NLR水平,采用Logistic回归分析预后影响因素,采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评估微炎症指标及NLR对预后的预测价值。结果两组性别、年龄、身体质量指数(body mass index,BMI)、原发病、透析通路、合并心血管疾病、血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)比较,差异无统计学意义(P>0.05);死亡组透析时间≥12个月、血肌酐(serum creatinine,sCr)、IL-6、hs-CRP、SAA及NLR水平均高于生存组(P<0.05);经Logistic回归分析,透析时间、sCr、SAA、NLR均为预后的影响因素(P<0.05);经ROC分析显示,SAA、NLR预测终末期MHD患者预后的截断值为65.89 mg/L、3.48%,曲线下面积(area under curve,AUC)值为0.878、0.872,联合预测的AUC值为0.944。结论微炎症指标联合NLR对终末期MHD患者预后具有一定预测价值。

Objective To study the prognostic value of microinflammation index combined with neutrophil-to-lymphocyte ratio(NLR)in patients with end-stage maintenance hemodialysis(MHD).Methods One hundred and ten patients with end-stage MHD in Hefei Second People’s Hospital from February 2018 to February 2021 were selected.The microinflammatory indexes[interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),serum amyloid protein(SAA)]and NLR were detected.According to the mortality within one year,they were divided into death group(n=23)and survival group(n=87).The general data,microinflammation index and NLR level of the two groups were compared,the influencing factors of prognosis were analyzed by Logistic regression,and the predictive value of microinflammation index and NLR on prognosis was evaluated by receiver operating characteristics(ROC)curve.Results There was no significant difference in gender,age,body mass index(BMI),primary disease,dialysis pathway,combined cardiovascular disease,hemoglobin(Hb),albumin(ALB),total cholestrerol(TC),triacylglycerol(TG)between the two groups(P>0.05).The dialysis time≥12 months,the levels of sCr,IL-6,hs-CRP,SAA and NLR in the death group were higher than those in the survival group(P<0.05).Logistic regression analysis showed that dialysis time,sCr,SAA and NLR were the prognostic factors(P<0.05).ROC analysis showed that the cut off value of SAA and NLR in predicting the prognosis of patients with end-stage MHD was 65.89 mg/L,3.48%,the area under curve(AUC)value was 0.878,0.872,and the AUC value predicted jointly was 0.944.Conclusion Microinflammation index combined with NLR has a certain predictive value for the prognosis of patients with end-stage MHD.