初诊断2型糖尿病患者外周血中性粒细胞/淋巴细胞比值变化的临床研究

Clinical research on the change of neutrophil-lymphocyte ratio in newly diagnosed type 2 diabetic patients

目的探讨中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)在初诊断2型糖尿病患者外周血中的变化情况,并分析NLR与糖代谢之间的关系。方法回顾性分析2010年1月至2012年12月在中山大学附属第三医院接受诊治和体检的521例研究对象的临床资料。所有研究对象均签署由医院伦理委员会批准的知情同意书,符合医学伦理学规定。根据血糖检测水平的不同将研究对象分为2型糖尿病组、糖尿病前期组和正常血糖组。其中2型糖尿病组为初诊断但未接受降糖治疗的2型糖尿病患者,共258例,男127例,女131例;平均年龄(54±12)岁。糖尿病前期组80例,男30例,女50例;平均年龄(55±12)岁。正常血糖组183例,男76例,女107例;平均年龄(55±9)岁。比较3组间白细胞计数、中性粒细胞百分比、淋巴细胞百分比、中性粒细胞绝对值、淋巴细胞绝对值和NLR水平。此外,按照空腹血糖(fasting plasma glucose,FPG)水平的不同将研究对象分为FPG≤7 mmol/L、7 mmol/L<FPG<11 mmol/L和FPG≥11 mmol/L组;按照糖化血红蛋白(glycosylated hemoglobin A1c,Hb A1c)水平的不同将研究对象分为Hb A1c≤6.5%、6.5%<Hb A1c<9%和Hb A1c≥9%组。分别分析NLR与FPG和Hb A1c的相关性。2型糖尿病组、糖尿病前期组和正常血糖组研究对象临床资料的比较采用单因素方差分析,两两比较采用LSD-t检验;NLR和血糖水平的相关性分析采用Pearson相关分析法。结果 2型糖尿病组、糖尿病前期组和正常血糖组研究对象间白细胞计数和淋巴细胞绝对值比较差异无统计学意义(F=0.228、2.735,P>0.05)。2型糖尿病组患者与正常血糖组相比,中性粒细胞百分比和绝对值明显增加,淋巴细胞百分比明显减少,NLR明显增加(LSD-t_(中性粒细胞百分比)=6.332,LSD-t_(中性粒细胞绝对值)=3.111,LSD-t_(淋巴细胞百分比)=4.299,LSD-t_(NLR)=5.016,P值均<0.05)。糖尿病前期组研究对象与正常血糖组相比,中性粒细胞百分比明显增加,淋巴细胞百分比明显减少,NLR明显增加(LSD-t_(中性粒细胞百分比)=2.154,LSD-t_(淋巴细胞百分比)=2.785,LSD-t_(NLR)=2.871,P值均<0.05)。随着FPG和Hb A1c的逐渐升高,NLR也逐渐增加,NLR与FPG、Hb A1c均呈正相关性(r=0.14、0.12,P值均<0.05)。结论初诊断2型糖尿病患者的NLR水平升高提示患者机体存在一定程度的慢性炎症;NLR水平升高与血糖控制不佳存在一定的相关性,有可能成为预测2型糖尿病慢性炎症状态的新指标之一。

ObjectiveTo investigate the change of neutrophil/lymphocyte ratio （NLR） in the peripheral blood of newly diagnosed type 2 diabetic patients and the correlation between NLR and glycometabolism.Methods Clinical data of 521 subjects undergoing medical examinations or receiving diagnoses and treatments in the Third Affiliated Hospital of Sun Yat-sen University-Lingnan Hospital between January 2010 and December 2012 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to different blood glucose levels, the subjects were divided into the type 2 diabetes group, prediabetes group and euglycemia group. The type 2 diabetes group was composed of newly diagnosed type 2 diabetes subjects without any treatments before, including 258 subjects. Among them, 127 were males and 131 were females with an average age of （54±12） years old. Among the 80 subjects of the prediabetes group, 30 were males and 50 were females with an average age of （55±12） years old. Among the 183 subjects of the euglycemia group, 76 were males and 107 were females with an average age of （55±9） years old. Leucocyte count, percentage of neutrophil and lymphocyte, absolute value of neutrophil and lymphocyte, and NLR were compared among the three groups. In addition, according to the FPG levels, the subjects were divided into the FPG≤7 mmol/L group, 7 mmol/L〈FPG〈11 mmol/L group and FPG≥11 mmol/L group. While according to the HbA1c levels, the subjects were divided into the HbA1c≤6.5% group, 6.5%〈HbA1c〈9% group and HbA1c≥9% group. The correlations between NLR and FPG, HbA1c were analyzed. The comparisons of clinical indexes of the type 2 diabetes group, prediabetes group and euglycemia group subjects were conducted using one-way ANOVA analysis, with LSD-t test for pairwise comparison. The correlation analysis between NLR and blood glucose level was conducted using Pearson correlation analysis.Results There were no statistical difference among the type 2 diabetes group, prediabetes group and euglycemia group in leucocyte count and neutrophil absolute value （F=0.228, 2.735,P〉0.05）. Compared with those in euglycemia group, percentage and absolute value of neutrophil in the type 2 diabetes group were significantly higher, percentage of lymphocyte was significantly lower, and the NLR was significantly higher （LSD-t=6.332, 3.111, 4.299, 5.016,P〈0.05）. Compared with those in euglycemia group, percentage of neutrophil in the prediabetes group was significantly higher, percentage of lymphocyte was significantly lower, and the NLR was significantly higher （LSD-t=2.154, 2.785, 2.871,P〈0.05）. NLR increased gradually along with the increase of FPG and HbA1c, NLR was positively correlated with FPG and HbA1c （r=0.14、0.12,P〈0.05）.Conclusions Increased NLR level was found in newly diagnosed type 2 diabetic patients, indicating some degree of chronic inflammation. Increased NLR level was related to poor blood glucose control and it may become a new index to predict the chronic inflammation status of type 2 diabetes.