外周血炎症细胞比值与慢性肾脏病患者微炎症的关系研究

Relationship between the ratio of inflammatory cells in peripheral blood and microinflammation in patients with chronic kidney disease

目的研究中性粒细胞淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)与慢性肾脏病(CKD)患者体内微炎症状态的相关性。方法选取2016年8月至2017年10月在武汉大学人民医院肾内科住院治疗的210例CKD患者作为研究对象,将其分为3组,透析前CKD3～5期患者50例(透析前组)、稳定的维持性血液透析(MHD)患者90例(MHD组)及腹膜透析(PD)患者70例(PD组),另选取武汉大学人民医院年龄及性别匹配的健康体检者30名作为健康对照组。检测所有研究对象血常规、血生化指标及超敏C反应蛋白(hs-CRP),计算NLR、PLR值,分析各组指标之间的差异及NLR、PLR与各指标的相关性。依据hs-CRP水平将210例CKD患者分为hs-CRP低水平组(≤3.0mg/L)和hs-CRP高水平组(>3.0mg/L),hs-CRP>3.0 mg/L提示存在心血管疾病高风险,分析2组间各指标的差异,并计算NLR、PLR评估心血管疾病危险性的敏感性和特异性。结果与健康对照组比较,CKD患者的NLR、hs-CRP显著升高,MHD组及PD组的PLR显著升高(P<0.05);CKD患者的NLR、PLR与hs-CRP成正相关(P<0.05)。hs-CRP>3.0mg/L的CKD患者年龄、NLR和PLR均较高(P<0.05),存在心血管疾病高风险;NLR和PLR的敏感性及特异性分别为78.8%、53.3%和78.8%、41.7%。结论 NLR可作为CKD患者反映体内微炎症状态的指标,PLR可作为CKD透析患者反映体内微炎症状态的指标,两者都可以评估心血管疾病危险性,是容易检测而且廉价的实验室指标。

Objective To evaluate the association of neutrophil-to-lymphocyte ratio（NLR）and platelet-to-lymphocyte ratio（PLR）with the microinflammation status in patients with chronic kidney disease（CKD）.Methods 210 CKD patients who received treatment in Department of Nephrology,Renmin Hospital of Wuhan University from August 2016 to October2017 were recruited for this study.They were divided into three groups：50 CKD patients（at stage 3-4）before dialysis as pre-dialysis group,90 CKD patients receiving maintenance hemodialysis（MHD）with stable clinical conditions as MHD group,and70 CKD patients given peritoneal dialysis（PD）with stable clinical conditions as PD group.Thirty healthy individuals served as the healthy control group.Blood routine examination was done,and laboratory indicators and hsCRP were determined.NLR and PLR were calculated.Statistical differences of laboratory indicators among the 4 groups were analyzed.The correlation among NLR,PLR and other Laboratory indicators were analyzed also.According to the hs-CRP levels,210 CKD patients were divided into hs-CRP low level group（≤3 mg/L）and hs-CRP high level group（3 mg/L）.hs-CRP3.0 mg/L suggests a high risk of cardiovascular disease.Statistical differences of laboratory indicators between the two groups were analyzed.The sensitivity and specificity of NLR and PLR to assess the risk of cardiovascular disease were calculared.Results In CKD patients,NLR and hsCRP were significantly higher than in healthy control group（P〈0.05）.In MHD group and PD group,PLR were significantly higherthan in healthy control group（P〈0.05）.NLR and PLR were positively correlated with hs-CRP in CKD patients（P〈0.05）.As compared with hs-CRP low level group,age,NLR and PLR in hs-CRP high level group were significantly increased（P〈0.05 for all）.There was a high risk of cardiovascular disease in hs-CRP high level group.In hsCRP low level group and hs-CRP high level group,the sensitivity and specificity of NLR were78.8% and53.3%,and those of PLRwere 78.8% and41.7%,respectively.Conclusions NLR may be used as amarker of systemic microinflammation statusin patients with CKD,PLR may be used as a marker of systemic microinflammation status in dialysis patients with CKD,they can evaluation the risk of cardiovascular diseases,they are inexpensive and parameter easily found in Blood routine examination.