原发性高血压患者血中性粒细胞/淋巴细胞比值与微量白蛋白尿的关系

Relationship between neutrophil to lymphocyte ratio and microalbuminuria in essential hypertensive patients

目的探索在原发性高血压人群中性粒细胞/淋巴细胞比值(NLR)与微量白蛋白尿(MAU)的相关性,并与传统预测因子同型半胱氨酸及超敏C反应蛋白对MAU的诊断价值进行比较。方法收集2012年11月至2014年10月大连医科大学附属第一医院高血压科住院的原发性高血压患者222例,分为原发性高血压组(n=121)与原发性高血压合并微量白蛋白尿组(n=101)。记录各组性别、年龄、身高、体重、吸烟史、他汀类药物与血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂类药物应用史、血压;入院次日晨收集尿及空腹血,测量尿微量白蛋白、尿肌酐及血常规、血脂、血清同型半胱氨酸、超敏C反应蛋白、血清肌酐。计算体重指数、尿微量白蛋白/尿肌酐比值、肌酐清除率及血中性粒细胞/淋巴细胞比值。结果原发性高血压组与原发性高血压合并蛋白尿组的收缩压、舒张压、血清同型半胱氨酸、超敏C反应蛋白、血中性粒细胞/淋巴细胞比值比较有统计学差异[(166.16±20.24)vs.(175.24±20.25)mm Hg;(104.56±12.74)vs.(109.99±16.35)mm Hg;(0.84±0.15)vs.(0.92±0.10)μmol/L;(1.08±1.05)vs.(3.04±6.91)mg/L;(1.78±0.80)vs.(1.29±0.36);均P<0.05]。血中性粒细胞/淋巴细胞比值与尿微量白蛋白/尿肌酐比值呈正相关(r=0.260,P=0.000),且为微量白蛋白尿的独立危险因素;Logistics多元回归分析提示,其与微量白蛋白尿的相关系数小于血清同型半胱氨酸,但明显大于超敏C反应蛋白。结论 NLR升高可能是高血压患者出现微量白蛋白尿的独立危险因素;其与微量白蛋白尿的相关性可能弱于血清同型半胱氨酸,但明显强于超敏C反应蛋白。

Objective To assess the relationship between neutrophil to lymphocyte ratio （NLR） and microalbuminuria （MAU） in essential hypertensive （EH） patients and to compare the diagnostic efficacy of microalbuminuria between NLR and homocysteine （Hey）, high sensitivity C -reactive protein （hs- CRP）. Methods A total of 222 adult hospitalized EH subjects were divided into EH ＋ MAU （MAU） group （ n = 101 ） and EH group （ n = 121 ） according to whether combined with MAU. Background data, including gender, age, smoking, body weight, height, systolic blood pressure （ SBP）, diastolic blood pressure （ DBP）, cholesterol, glyeerides, low density lipoprotein （ LDL）, high densi- ty lipoprotein （HDL） , fasting blood glucose （FBG） , Hcy, hs - CRP, creatinine, and history of medication of statins or ACEI/ARB were collected. BMI, creatinine clearance, urine microalbumin/creatinine ratio （UACR）, and NLR were calculated respectively. Results Compared with the EH group, the SBP, DBP, Hcy, hs - CRP and NLR of MAU group were significantly increased （ 166. 16 ± 20.24 ） vs. （ 75.24 ± 20.25 ） mmHg, （ 104. 56 ±12.74 ） vs. （109.99 ±16.35） mmHg, （0.84 ±0.15） vs. （0.92 ±0.10） p.mol/L, （1.08±1.05） vs. （3.04 ±6.91） mg/L, （ 1.78 ± 0.80） vs. （ 1.29 2 0.36 ）, P 〈 0.05, respectively. NLR was positively correlated with UACR （ r = 0. 260, P = 0. 000）. Logistics multivariate regression analysis showed that the correlation coefficient of NLR and MAU was lower than that of Hey, but significantly higher than that of hs - CRP. Conclusion NLR could probably be an independent risk factor of MAU in hypertensive patients, the association of NLR with MAU might be weaker than that of Hcy, but higher than that of hs - CRP.