中性粒与淋巴细胞比值与2型糖尿病肾病的相关性

Relationship between neutrophils to lymphocytes ratio and type 2 diabetic kidney disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)与2型糖尿病肾病(DKD)的相关性。方法选取2012年7月～2018年6月于北京潞河医院住院治疗的2型糖尿病患者148例,根据患者8 h尿微量白蛋白排泄率(8°UAER)分为5组:8°UAER<20μg/min、血清肌酐正常30例为DM1组;20μg/min≤8°UAER<200μg/min、血清肌酐正常30例为DM2组;8°UAER≥200μg/min、血清肌酐正常28例为DM3组;8°UAER≥200μg/min、血清肌酐>120μmol/L但尚未透析者29例为DM4组;DM5组为临床诊断DKD行血液透析治疗患者,共31例。选取健康对照者29名为对照组(N组)。空腹静脉采血,检测各组血常规、血糖、血脂、肝肾功,DM1、DM2、DM3、DM4组留取8 h尿,检测8°UAER。结果随着DKD进展,NLR逐渐升高,DM4、DM5组高于N、DM1、DM2、DM3组(P <0.05或P <0.01),DM3组高于N组和DM1组(P <0.05)。Pearson相关分析结果显示NLR与年龄(r=0.317,P <0.001)、病程(r=0.306,P <0.001)、8°UAER(r=0.293,P=0.006)、尿素氮(r=0.404,P <0.001)、全段甲状旁腺激素(iPTH)(r=0.465,P <0.001)呈正相关,与肾小球滤过率(r=-0.438,P <0.001)、白蛋白(r=-0.194,P=0.019)、高密度脂蛋白胆固醇(r=-0.182,P=0.028)呈负相关。多元线性回归方程:YLog NLR=0.29+0.54Log8°UAER+0.004年龄(R2=0.152,P=0.001);ROC曲线显示,以NLR=2.29作为切点,诊断DKD的灵敏度和特异度分别为52.6%、73.3%(ROC曲线下面积是0.661,95%CI:0.544～0.779,P=0.014)。结论 NLR在DKD进展过程中逐渐升高,在临床蛋白尿的2型糖尿病患者中显著升高,与8°UAER呈正相关,但NLR升高晚于8°UAER,提示NLR升高可预测DKD的发生。

Objective To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR)and type 2 diabetic kidney disease(DKD).Methods A total of 148 patients with type 2 diabetes mellitus admitted to Beijing Luhe Hospital from July 2012 to June 2018,and they were divided into 5 groups according to urine albumer excretion rate in 8 h(8°UAER).Thirty patients with 8°UAER<20μg/min and normal serum creatinine were DM1 group;30 patients with 20μg/min≤8°UAER<200μg/min and normal serum creatinine were DM2 group;28 patients with 8°UAER≥200μg/min and normal serum creatinine were DM3 group;29 patients with 8°UAER≥200μg/min and serum creatinine >120μmol/L,not yet been dialysis were DM4 group;31 patients diagnosed as DKD and been dialysis were DM5 group.Twenty-nine health control individuals were selected as control group(N group).Blood was collected by fasting vein.Blood routine examination,glucose,lipid,liver and kidney function were examined in each group.Eight-hour urine in DM1,DM2,DM3 and DM4 group were collected and 8°UAER were detected.Results NLR gradually increased in DKD progress and NLR in DM4 and DM5 group were higher than that in N,DM1,DM2,DM3 group(P<0.05 or P<0.01),NLR in DM3 group was higher than that in N and DM1 group(P<0.05).The results of Pearson correlation analysis showed that NLR was positively correlated with age(r=0.317,P<0.001),course of disease(r=0.306,P<0.001),8°UAER(r=0.293,P=0.006),urea nitrogen(r=0.404,P<0.001),total parathyroid hormone(iPTH)(r=0.465,P<0.001)and was negatively correlated with glomerular filtration rate(r=-0.438,P<0.001),albumin(r=-0.194,P=0.019),high-density lipoprotein cholesterol(r=-0.182,P=0.028).Multiple linear regression equation:YLogNLR=0.29+0.54Log8°UAER+0.004 age(R2=0.152,P=0.001).ROC curve showed NLR=2.29 as the cut point,and the sensitivity and specificity of DKD diagnosis were 52.6%and 73.3%(area under the ROC curve is 0.661,95%CI:0.544-0.779,P=0.014).Conclusion NLR gradually increases during the progression of diabetic nephropathy,and is significantly high in patients with type 2 diabetes mellitus with proteinuria.It is positively correlated with 8°UAER,but the increase of NLR is later than 8°UAER,suggesting that increasing NLR may predict the occurrence of diabetic kidney disease.