中性粒细胞与淋巴细胞比值对不同比例新月体紫癜性肾炎相关性分析

The correlation of neutrophil to lymphocyte ratio with proportional crescent purpura nephritis

目的评价中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、单核细胞与高密度脂蛋白比值(monocyte-to-high density lipoprotein ratio,MHR)与不同比例新月体紫癜性肾炎的相关性。方法选取2016年1月至2019年7月在武汉大学人民医院行肾穿刺活检确诊为紫癜性肾炎患者47例,依据年龄分组,18岁以下为儿童组,18岁以上为成人组,依据新月体比例分为无新月体组(C0组),新月体比例<25%组(C1组),新月体比例≥25%组(C2组);收集患者的生化指标,包括中性粒细胞值、淋巴细胞值、单核细胞值、高密度脂蛋白、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、尿素氮(BUN)、肌酐(Scr)、尿酸(uric acid,UA)、白蛋白(ALb)、前白蛋白(prealbumin,PA)、补体C1q、补体C3、补体C4、IgG、IgM、IgA、IgE、24 h尿蛋白,计算NLR、MHR。分析各指标在不同年龄紫癜性肾炎患者以及不同比例新月体紫癜性肾炎患者的差异。结果不同年龄患者的hs-CRP、IgA、C4、Scr水平有显著差异(P<0.05)。在不同比例新月体紫癜性肾炎患者中,hs-CRP、IgA、补体C1q、补体C3、BUN、Alb差异有统计学意义(P<0.05),进一步两两比较,C0组hs-CRP分别与C1组、C2组比较,差异有统计学意义(P<0.05),C0组IgA与C1组比较,差异有统计学意义(P<0.05),C1组补体C1q与C2组比较,差异有统计学意义(P<0.05),C1组补体C3分别与C0组、C2组比较,差异有统计学意义(P<0.05),C2组BUN、Alb分别与C0组、C1组比较,差异有统计学意义(P<0.05)。C0、C1、C2组患者PA、IgG、IgM、IgE、UA、Scr、补体C4、24 h尿蛋白水平比较,差异无统计学意义。Spearman相关性分析显示,NLR与PA(r=0.299)、hs-CRP(r=0.369)、Scr(r=0.305)、BUN(r=0.353)、新月体评分(r=0.320)存在显著正相关(P<0.05);MHR与IgM存在显著负相关(r=-0.435,P<0.05),与UA(r=0.404)、BUN(r=0.296)、Scr(r=0.377)存在正相关(P<0.05),与新月体评分无相关性;hs-CRP与新月体评分有显著正相关(r=0.346,P=0.017)。以新月体评分>1分为分类变量绘制ROC曲线,结果显示NLR评价紫癜性肾炎新月体的临界值为4.60,ROC曲线下面积为0.737(95%CI 0.567~0.907,P=0.036),灵敏度为62.5%,特异度为79.5%。结论在紫癜性肾炎患者中NLR、MHR与肾功能有显著的相关性,NLR与新月体比例和hs-CRP有关,hs-CRP与新月体比例有关,说明NLR在紫癜性肾炎中作为炎症免疫指标是有意义的,MHR在紫癜性肾炎中能否成为炎症免疫指标有待进一步研究。

Objective To evaluate the correlation between neutrophil to lymphocyte ratio(NLR)and monocytes to high density lipoprotein ratio(MHR)with proportional crescent henoch-schonlein purpura nephritis(HSPN).Methods Forty-seven patients diagnosed with purpura nephritis by renal biopsy in People’s Hospital of Wuhan University from January 2016 to July 2019 were selected and divided into children group(age<18)and adult group(age≥18).According to the proportion of crescent,they were divided into non-crescent group(group C0),crescent<25%group(group C1),and crescent≥25%group(group C2).The following data of the patients were collected:neutrophil count,lymphocyte count,monocyte mount,high density lipoprotein,hypersensitive C-reactive protein(hs-CRP),blood urea nitrogen(BUN),serum creatinine(Scr),uric acid(UA),albumin(ALb),prealbumin(PA),complement C1q,C3 and C4,IgG,IgM,IgA,IgE,24h urinary protein.NLR and MHR were calculated.The differences of each index between different age groups and between different proportions of crescent in HSPN were analyzed.Results The difference of hs-CRP,IgA,C4 and Scr in different age groups was statistically significant(P<0.05).There were statistically significant differences in hs-CRP,IgA,C1q,C3,BUN and Alb among different proportions of crescent in HSPN(P<0.05).Furthermore,the differences of hs-CRP between group C0 and group C1/C2(P<0.05),IgA between group C0 and group C1(P<0.05),complement C1q between group C1 and group C2(P<0.05),complement C3 between group C1 and group C0/C2(P<0.05),BUN and Alb levels between group C2 and group C0/C1(P<0.05)were all statistically significant.There were no statistically significant differences in PA,IgG,IgM、IgE,UA,Scr,C4 and 24h urinary protein.Spearman correlation analysis showed that NLR had significantly positive correlation(P<0.05)with PA(r=0.299),hs-CRP(r=0.369),Scr(r=0.305),BUN(r=0.353),proportion of crescent(r=0.320).MHR exhibited significantly negative correlation with IgM(r=-0.435,P<0.05);positive correlation(P<0.05)with UA(r=0.404),BUN(r=0.296),Scr(r=0.377);and no correlation with crescent proportions.Hs-CRP was significantly positively correlated with the proportion of crescent(r=0.346,P=0.017).According to the pathological results,glomerulus were graded and ROC curve was drawn with crescent score as the classification variable.The results showed that the critical value of NLR to evaluate the crescent during HSPN was 4.60,AUC was 0.737(95%CI 0.567~0.907,P=0.036),sensitivity 62.5%,and specificity 79.5%.Conclusions In HSPN,NLR and MHR are significantly correlated with renal function,NLR is related to the proportion of crescent and hs-CRP,and Hs-CRP is related to the proportion of crescent,which indicates that NLR is a significant inflammatory immune index in HSPN.MHR as an inflammatory immune index in HSPN needs further studies.