血小板/淋巴细胞、中性粒细胞/淋巴细胞比值与血液透析患者蛋白质能量消耗的关系

Association of platelet/lymphocyte ratio and neutrophil/lymphocyte ratio with protein-energy wasting in maintenance hemodialysis patients

目的探讨血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)与维持性血液透析(MHD)患者蛋白质能量消耗(PEW)的关系。方法采用多中心横断面研究,收集2017年6至8月于贵州省11家血液透析中心行MHD治疗的成人患者一般资料及实验室检查结果,同时进行物理测量及人体成分分析。根据血常规计算PLR、NLR,按两者的中位数及上下四分位数将研究对象分为四组(Q1~Q4组),比较四组间各指标的差异,采用多因素logistic回归分析PLR、NLR水平与PEW的关系,同时应用受试者工作特征曲线(ROC)分析并比较两者对MHD患者PEW的预测价值。结果共纳入资料完整的研究对象936例,其中男519例,女417例,年龄(55.6±15.6)岁,PEW患病率为46.2%(432/936)。多因素logistic回归分析显示,在未调整模型中,PLRQ3、Q4组MHD患者的PEW发生风险分别为PLRQ1组患者的2.07倍(95%CI:1.03~4.13,P=0.014)、2.73倍(95%CI:1.58~4.74,P<0.001)。调整年龄、性别、高血压、糖尿病、血红蛋白后,PLR仍与PEW发生风险有关,PLRQ3、Q4组的PEW发生风险分别为PLRQ1组患者的2.82倍(95%CI:1.42~5.60,P=0.003)、2.93倍(95%CI:1.50~5.73,P=0.002)。经ROC分析发现,PLR预测MHD患者PEW的最佳阈值为144.09,灵敏度、特异度分别为61%、58%,曲线下面积为0.61(95%CI:0.56~0.66,P<0.001)。NLR预测MHD患者PEW的曲线下面积为0.55(P=0.091)。结论两指标中仅PLR为MHD患者发生PEW的相关因素,可能可以用于预测MHD患者PEW的发生。

Objective To explore the association of platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province from June to August, 2017. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. PLR and NLR were calculated according to routine blood test. All patients were divided into four groups (Q1-Q4) according to the median and quartile of PLR and NLR. Multivariate logistic regression models were applied to analyze the relationships between PLR, NLR and PEW. The comparison of predictive power of PLR and NLR for PEW was evaluated by receiver operating characteristic curve (ROC). Results A total of 936 MHD patients were enrolled (519 males, 417 females), with a mean age of (55.6±15.6) years. The prevalence of PEW was 46.2%(432/936). Multivariate logistic regression analysis showed that patients in group PLR Q3 and Q4 were 2.07 (95%CI: 1.03-4.13, P=0.014) and 2.73 (95%CI: 1.58-4.74, P<0.001) times more likely to have PEW, compared with those in group PLR Q1 in unadjusted models. PLR was significantly associated with the development of PEW after adjusting age, sex, history of hypertension, diabetes and hemoglobin. Patients in Group PLR Q3 and Q4 were 2.82 times (95%CI: 1.42-5.60, P=0.003) and 2.93 times (95%CI: 1.50-5.73, P=0.002) times more likely to have PEW than those in Group PLR Q1. The ROC showed that only PLR can predict the development of PEW with a diagnostic threshold of 144.09 [area under curve (AUC)=0.61, 95%CI: 0.56-0.66, P<0.001], with a sensitivity and specificity of 61% and 58%, respectively, while the AUC of NLR is 0.55 (P=0.091). Conclusion For MHD patients, only PLR could be a relevent factor of PEW and it showed the predictive power of PEW rather than NLR.