维持性血液透析患者血中性粒细胞/淋巴细胞值的测定及临床意义

Clinical value of neutrophil to lymphocyte ratio in maintenance hemodialysis patients

目的 探讨维持性血液透析（MHD）患者外周血中性粒细胞/淋巴细胞值（NLR）对评估炎症状态及预测心血管事件的相关性.方法 选取我院2015年10-12月收治的MHD患者108例,记录一般资料、血常规、生化、铁代谢指标及透析前血压数值,根据NLR中位数（2.82）将患者分为低NLR组和高NLR组（各54例）.所有患者随访18个月,记录此期间发生的心血管事件.结果 高NLR组患者透析龄、外周血白细胞计数、中性粒细胞数、NLR及高敏CRP（hsCRP）水平,均显著高于低NLR组[（88.0±50.4）与（62.4±40.6）个月,=2.48,P=0.02;（6.96±1.82）×109/L与（5.83 ±1.33） ×109/L,t=3.14,P=0.00;（4.94±1.38）×109/L与（3.36±0.87）×109/L,t =6.08,P =0.00;4.16 ±1.25与2.15±0.46,t=9.48,P=0.00;（7.85±4.92）与（3.13 ±2.23） mg/L,t=4.97,P=0.00],而淋巴细胞数和转铁蛋白饱和度显著低于低NLR组[（1.25±0.40）×109/L与（1.58±0.34）×109/L,=3.97,P=0.00;（25.7±10.2）％与（32.6±17.2）％,t=2.17,P=0.03].两组患者年龄、性别构成比、患糖尿病比例、透前收缩压和舒张压水平、尿素清除指数（Kt/V）、血红蛋白、血清铁蛋白、血钙、血磷、全段甲状旁腺激素、白蛋白、血肌酐、二氧化碳结合力及血脂各项指标比较,差异均无统计学意义（均P＞0.05）.Spearman相关分析显示MHD患者NLR与透析龄、hsCRP水平呈正相关（r=0.311,P=0.01;r =0.574,P=0.00）;白细胞计数和中性粒细胞数亦与hsCRP水平显著正相关（r =0.327,P=0.00;r =0.488,P=0.00）,而淋巴细胞数与hsCRP水平无显著相关性（r=0.211,P=0.06）.低NLR组患者中发生心血管事件9例（16.7％）,高NLR组患者中发生心血管事件20例（37.0％）,两组差异有统计学意义（x2=5.70,P =0.03）.Cox回归分析显示年龄、NLR和血磷是MHD患者发生心血管事件的危险因素（HR=1.075,P=0.00;HR=1.646,P=0.00;HR=1.912,P=0.02）.结论 NLR能够反映MHD患者的炎症状态,可能是MHD患者发生心血管事件的危险因素.

Objective To investigate the clinical value of neutrophil to lymphocyte ratio （NLR） in evaluation of inflammation and prediction of cardiovascular events in maintenance hemodialysis （MHD） patients.Methods One hundred and eight stable MHD patients were recruited from Dialysis Center of Beijing Tongren Hospital from October 2015 to December 2015.The general information,complete blood count,hsCRP,biochemical test,iron metabolic indicators,pre-dialytic systolic blood pressure （SBP） and diastolic blood pressure （DBP） were recorded.MHD patients were divided into the low NLR group and high NLR group according to the median of NLR （2.82）.All patients were followed up for 18 months,cardiovascular events （CVE） were recorded during this period.Results In the high NLR group the dialysis vintage,white blood cell count,neutrophil count,NLR and hsCRP were significantly higher than those in the low NLR group [（88.0 ± 50.4） vs.（62.4 ± 40.6） months （t =2.48,P =0.02）,（6.96 ± 1.82） × 109/L vs.（5.83 ± 1.33） × 109/L（t =3.14,P=0.00）,（4.94 ± 1.38） × 109/L vs.（3.36 ±0.87） × 109/ L（t=6.08,P=0.00）,（4.16±1.25） vs.（2.15 ±0.46） points（t=9.48,P=0.00）,（7.85±4.92） vs.（3.13 ± 2.23） mg/L （t =4.97,P =0.00）].In the high NLR group lymphocyte count and transferrin saturation were significantly lower than those in the low NLR group[（1.25 ± 0.40） × 109/L vs.（1.58 ± 0.34） ×109/L,t=3.97,P=0.00;（25.7±10.2）％ vs.（32.6±17.2）％,t=2.17,P=0.03].There were no significant differences in age,sex,diabetes proportion,pre-dialytic SBP,pre-dialytic DBP,urea clearence index（Kt/V）,hemoglobin,serum ferritin,serum calcium,serum phosphorus,intait parathyroid hormone,albumin,serum creatinine,carbon dioxide binding capacity and blood lipids between the two groups （P ＞ 0.05）.Bivariate correlation analysis showed that NLR was positively correlated with dialysis vintage and hsCRP （r =0.311,P =0.01;r =0.574,P =0.00）;white blood cell count and neutrophil count were positively correlated with hsCRP （r =0.327,P =0.00;r =0.488,P =0.00）.During follow-up period 9 cases of CVE （16.7％） and 20 cases of CVE （37.0％） occurred in the low NLR group and high NLR group,respectively （x2 =5.70,P =0.03）.Cox regression analysis showed that age,NLR and serum phosphorus level were risk factors of CVE in MHD patients （HR =1.075,P =0.00,HR =1.646,P =0.00;HR =1.912,P =0.02）.Conclusion NLR can predict inflammation and is one of the risk factors for CVE in MHD patients.