中性粒细胞与淋巴细胞比值在血液透析患者中的临床意义

Clinical significance of neutrophil to lymphocyte ratio in maintenance hemodialysis patients

目的 探讨中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）在维持性血液透析患者炎症状态评估中的临床意义.方法 选择2010年5月～2012年5月首都医科大学附属康复医院就诊的维持血液透析患者（透析龄均＞3个月）的患者65例为透析组,选择同时期健康体检者45例为体检组.入选者均检测血常规、超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、血清白蛋白（Alb）、高密度脂蛋白胆固醇（HDL-C）、血红蛋白（Hb）,并计算中性粒细胞/淋巴细胞比值（NLR）值.分析hs-CRP、IL-6、Alb、HDL-C、Hb与NLR的相关性.结果 ①透析组患者NLR（4.67±4.17）、hs-CRP[4.02 （6.67,0.68）mg/L]、IL-6[（14.28±2.94）pg/mL]高于体检组[（1.91±0.67）、0.59（3.07,0.11）mg/L、（].52±0.54）pg/mL],差异均有统计学意义（P＜0.05）;透析组Alb[（39.15±3.67）g/L]、HDL-C[（0.89±0.23） mmol/L]、Hb[（102.1±30.6）g/L]低于体检组[（43.67±3.89） g/L、（1.09±0.21）mmol/L、（118.2±24.7）#L],差异有统计学意义（P＜0.05）.②单因素相关分析发现,hs-CRP（r=0.323,P＜ 0.01）、IL-6（r=0.405,P＜ 0.01）与NLR成正相关,ALB（r=-0.442,P＜0.01）、HDL-C（r=-0.353,P＜0.01）、Hb（r=-0.291,P＜ 0.01）与NLR呈负相关.多因素逐步线性回归分析表明,影响NLR的主要因素为hs-CRP、IL-6、Alb、HDL-C,标准回归系数（β）分别为0.296、0.387、-0.365、-0.356.结论 NLR可以为维持性血液透析患者提供重要的炎症信息,它是一个容易检测而且廉价的实验室指标.

Objective To investigate the clinical significance of neutrophil to lymphocyte ratio （NLR） in maintenance hemodialysis patients.Methods 65 cases of maintaining blood dialysis （more than 3 months） in Rehabilitation Hospital of the Capital University of Medical Sciences from May 2010 to May 2012 were selected as dialysis group,45 cases of healthy people in the same term were chosen as health control group.Blood routine examination,hs-CRP,IL-6,Alb,HDL-C,Hb,NLR were detected and calculated.The correlation among NLR and hs-CRP,IL-6,Alb,HDL-C,Hb were analyzed.Results ①The NLR,hs-CRP,IL-6 in dialysis group [（4.67±4.17）,4.02 （6.67,0.68） mg/L,（14.28±2.94） pg/mL] were higher than those in health control group [（1.91±0.67）,0.59 （3.07,0.11） mg/L,（1.52±0.54） pg/mL],the differences were statistically significant （P ＜ 0.05）.Alb,HDL-C,Hb in dialysis group [（39.15±3.67） g/L,（0.89±0.23） mmol/L,（102.1±30.6） g/L] were all lower than those in health control group [（43.67±3.89） g/L,（1.09±0.21） mmol/L,（118.2±24.7） g/L],the differences were statistically significant （P ＜ 0.05）.②The positive correlation was found among the NLR and hs-CRP （r =0.323,P ＜ 0.01）,IL-6 （r =0.405,P ＜ 0.01）; the negative correlation was found among the NLR and ALB （r =-0.442,P ＜ 0.01）,HDL-C （r =-0.353,P ＜ 0.01）,Hb （r =-0.291,P ＜ 0.01） according to the single factor correlation analysis.The main factors influencing NLR were the hs-CRP,IL-6,Alb,HDL-C （β =0.296,0.387,-0.365,-0.356） according to the multi-factor stepwise regression analysis.Conclusion The measure of NLR is easy and inexpensive and may provide significant information regarding inflammation in MHD patients.