血小板与淋巴细胞比值在老年人2型糖尿病致肾功能损伤患者中的相关性研究

The clinical application study of platelet to lymphocyte ratio in type 2 diabetes-induced renal impairment in elderly patients

目的 探讨老年2型糖尿病（T2DM）患者血小板与淋巴细胞比值（PLR）与肾功能受损程度的相关性. 方法 回顾性分析2017年1月至2018年1月就治于我院内分泌科的200例老年T2DM患者,单纯糖尿病100例（对照组）,糖尿病肾病患者100例（糖尿病肾病组）及同期至我院进行体检的100例健康志愿者（健康组）.糖尿病肾病组早期糖尿病肾病50例,中期27例,末期23例.对比分析对照组和健康组、糖尿病肾病组的一般资料、白蛋白和球蛋白比值（A/G）、糖化血红蛋白（HbA1c）、尿素氮、血肌酐、肾小球滤过率（eGFR）、24 h尿蛋白定量（24-UTP）、中性粒细胞与淋巴细胞比值（NLR）及PLR等指标,以老年T2DM患者是否进展为糖尿病肾病为因变量进行二项Logistic回归分析;采用Spearman相关系数进行PLR与HbA1c等指标的相关性分析. 结果 对照组、健康组及糖尿病肾病组两两比较体质指数、腰围、腰臀比、收缩压、病程、A/G、血肌酐、尿素氮、eGFR、24-UTP、白细胞介素6、超敏C反应蛋白（Hs-CRP）、PLR及NLR差异有统计学意义（均P＜0.05）;糖尿病肾病不同分期患者两两比较,A/G、血肌酐、尿素氮、eGFR、24-UTP、Hs-CRP、PLR及NLR,差异亦有统计学意义（均P＜0.05）;T2DM患者的A/G（OR：1.12,95％CI：0.89～1.65）、血肌酐（OR：200.34,95 ％CI：65.28～412.36）、尿素氮（OR：10.26,95％CI：8.34～16.94）、eGFR（OR：85.37,95％CI：78.31～103.57）、24-UTP（OR：187.32,95％CI：142.92～1523.49）、PLR（OR：81.51,95％CI：78.45～132.68）、NLR（OR：1.20,95％ CI：1.07～3.57）、IL-6（OR：4.25,95％CI：3.76～9.31）及Hs-CRP（OR：3.41,95％CI：2.35～10.51）水平可预测患者是否进展为糖尿病肾病（均P＜0.05）;PLR与A/G、Scr、BUN、eGFR、24-UTP、NLR、IL-6及Hs-CRP相关（r值分另为-0.338、0.469、0.521、-0.457、0.463、0.642、0.297、0.448,均P＜0.05）. 结论 PLR可反应老年T2DM患者进展为糖尿病肾病的风险、评估患者的肾功能,且廉价、易测,可在临床工作中推广.

Objective To explore the relationship between platelet to lymphocyte ratio（PLR） and the severity of renal impairment in elderly patients with type 2 diabetes mellitus （T2DM） Methods Two hundred elderly T2DM patients treated in our department of endocrinology from January 2017 to January 2018 included 100 cases with diabetic nephropathy（DN group）and 100 without nephropathy（control DM group）,and 100 individuals undergoing physical healthy examination during the same period（normal control group）were retrospectively enrolled.DN group included 50 early,27 medium and 23 end stage patients.Albumin to globulin ratio （A/G）,hemoglobin A1c （HbA1c）,urea nitrogen （BUN）,serum creatinine （Scr）,estimated glomerular filtration rate （eGFR）,24-hour urine protein quantification （24h-UTP）,neutrophil-lymphocyte ratio （NLR）,plateletlymphocyte ratio（PLR）,etc.were collected and compared among DN group,control DM group and normal control group.Binary Logistic regression analyses were performed to predict whether elderly patients with T2DM progress to DN.Correlations between PLR and HbA1c were analyzed using Spearman correlation coefficient.Results The BMI,waist circumference,waist-hip ratio,systolic blood pressure,disease duration,A/G,Scr,BUN,eGFR,24 h-UTP,interleukin 6 （IL-6）,hypersensitive C-reactive protein（hs-CRP）,PLR,and NLR showed statistically significant differences among three groups（all P 〈 0.05）.The differences in A/G,Scr,BUN,eGFR,24h-UTP,hs-CRP,PLR,and NLR between early,medium and end phases of DN were statistically significant （all P 〈 0.05）.The predictors for the progression to diabetic nephropathy were the levels of A/G（OR：1.12,95%CI：0.89-1.65）,Scr（OR：200.34,95%CI：65.28-412.36）,BUN（OR：10.26,95%CI：8.34-16.94）,eGFR （OR：85.37,95 % CI：78.31-103.57）,24h-UTP （OR：187.32,95 % CI：142.92-1523.49）,PLR （OR：81.51,95%CI：78.45-132.68）,NLR（OR：1.20,95%CI：1.07-3.57）,IL-6（OR：4.25,95%CI：3.76-9.31）,and hs-CRP （OR：3.41,95% CI：2.35-10.51） in T2DM patients.There were significant correlations of PLR with A/G,Scr,BUN,eGFR,24 UTP,NLR,IL-6,and hs-CRP （r =-0.338,0.469,0.521,-0.457,0.463,0.642,0.297,0.448,all P〈0.05）.Conclusions PLR,which is inexpensive and easy to measure,can predict the risk of progressing to DN in elderly T2DM patients and may evaluate their renal function,and is worth extending in clinical practice.