终末期肾病MHD患者NRL与近期心血管不良事件的相关性

An Analysis on Correlation of Neutrophil to Lymphocyte Ratio with Recent Cardiovascular Adverse Events in End-stage Renal Disease Patient Undergoing Maintenance Hemodialysis

目的:探讨终末期肾病维持性血液透析(MHD)者血液中性粒细胞与淋巴细胞比值(NRL)与近期发生心血管不良事件的相关性。方法:选取接受MHD终末期肾病患者170例,按照首次接受血透到访6个月期间是否发生心血管不良事件分为心血管不良事件组(n=60例)和无心血管不良事件组(n=110例),比较两组一般临床资料[年龄、性别、透析龄、是否接受红细胞生成素(EPO)治疗,收缩压(SBP)、舒张压(SDP)、超滤量]和实验室检查指标[血红蛋白(Hb)、白蛋白(ALB)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(SCr)、血尿素氮(BUN)、血磷、血钙、B型脑钠肽(BNP)、C反应蛋白(CRP)、中性粒细胞计数、淋巴细胞计数、白细胞计数(WBC),中性粒细胞计数绝对值/淋巴细胞计数绝对值(NLR)]的差异;按照170例患者的NLR的四分位数分为Q1组、Q2组、Q3组和Q4组,并利用Logistic回归方程分析4组患者的NRL与近期发生心血管不良事件的关系。结果:与无心血管不良事件组患者较,心血管不良事件组患者的龄偏大、SBP、TG、LDL-C、血磷、BNP、CRP、WBC、中性粒细胞计数较高(P<0.05),而Hb、淋巴细胞计数偏低(P<0.05),心血管不良事件组NRL水平高于心血管不良事件组(P<0.05);按照NRL水平四分位分组中比较,Q1组、Q2组、Q3组和Q4组中心血管不良事件总发生率分比为11.9%、27.9%、35.6%和67.7%,4组心血管事件发生率比较,差异有统计学意义(χ2=29.214,P<0.001);Logistic回归分析亦显示,NRL是心血管不良事件发生的独立危险因素(OR=2.421,95%CI:1.520~3.476,P<0.05)。结论:NRL水平增高可能是终末期肾病MHD患者发生近期心血管不良事件的独立危险因素。

Objective： to investigate the correlation of the ratio of neutrophils to lymphocytes （NLR） with the occurrence of cardiovascular adverse events in end-stage renal disease （ERD） patients undergoing maintenance hemodialysis （MHD）. Methods： One hundred and seventy cases of ERD patients receiving MHD were chosen as the research object, and were divided into cardiovascular adverse event group （group Y, n = 60） and no adverse cardiovascular event group （group N, n = 110） according to whether there occurred cardiovascular adverse events in 6 months of follow-up after the first hemodialysis. And, again, they were divided into groups of Q1, Q2, Q3, and Q4 according to their NLR values. The general clinical data and laboratory examination indexes of these groups were compared, and Logistic regression equation analysis was adopted for statistics analysis. Results： In group Y, patients were elder, and the systolic blood pressure, triglyceride, low density lipoprotein cholesterol, blood phosphorus, BNP, c-reactive protein, white blood cell counts, and neutrophil counts were higher （P 〈 0.05 ）, while low hemoglobin and lymphocyte counts were lower （P 〈 0.05 ） than those in group N. The NLR level of group Y （7.78 ± 1.65 ） was higher than that of group N （5.40 ± 1.11 ） （ t = 11. 238, P 〈0.05） ; Among groups Q1, Q2, Q3 and Q4, the center vessel total incidence of adverse events were 11.9%, 27.9%, 35.6%, and 27.9% respectively, and the differences were significant statistically （X^2 =29. 214 ,P 〈0. 001 ）. Logistic regression analysis showed that NLR was an independent risk factor for cardiovascular adverse events （ OR = 2. 421, 95% CI： 1. 520 - 3. 476, P 〈 0.05）. Conclusion： The increase of NLR level might be an independent risk factor of recent cardiovascular adverse events in ERD patients with MHD.