血小板/淋巴细胞比值在老年2型糖尿病患者肾功能损害及病情评估中的应用价值

Evaluation Value of Platelet to Lymphocyte Ratio for Renal Impairment and State of Disease in Elderly Patients with Type 2 Diabetes Mellitus

目的:研究血小板/淋巴细胞比值(PLR)在老年2型糖尿病(T2DM)患者肾功能损害及病情评估中的应用价值。方法:测定506例T2DM患者及250例健康体检者(对照组)的血常规、血糖、血脂、肝肾功等生化指标,并收集尿液测定尿白蛋白/肌酐比值(ACR)。根据《糖尿病肾病防治专家共识(2014年版)》,将T2DM患者分为DN组(n=279)和非DN组(n=227),并根据ACR将DN组分为微量白蛋白尿组(n=165,30~300 mg/24 h)、大量白蛋白尿组(n=114,≥300 mg/24 h)。比较各组患者临床指标,分析PLR与老年T2DM患者并发DN的相关性。结果:与对照组比较,非DN组、DN组HbAlc、FPG、2h PG、Scr、BUN、PLT、PLR明显升高,LYM明显下降(P<0.05);与非DN组比较,微量白蛋白尿组HbAlc、2h PG、Scr、UAER、eGFR明显升高,大量白蛋白尿组HbAlc、FPG、2h PG、Scr、BUN、UAER、eGFR、PLT、PLR明显升高,LYM明显下降(P<0.05);与微量白蛋白尿组,大量白蛋白尿组FPG、Scr、BUN、UAER、eGFR、PLT、PLR明显升高,LYM明显下降(P<0.05)。多因素logistics回归分析显示HbAlc、PLR是T2DM患者进展为DN的独立危险因素,而eGFR则是保护性因素(P<0.05)。HbAlc、eGFR、PLR联合预测T2DM患者并发DN的敏感性、特异性分别为83.1%,特异度为81.9%,均显著高于三个指标单独评估的敏感性、特异性(P<0.05)。结论:PLR是老年T2DM患者肾功能损害的独立危险因素,综合HbAlc、eGFR、PLR有助于老年T2DM患者并发DN及病情评估。

Objective:To explore the evaluation value of platelet to lymphocyte ratio(PLR)for renal impairment and state of disease in elderly patients with type 2 diabetes mellitus(T2 DM).Methods:Blood routine,blood glucose,blood lipids,liver and kidney function and other biochemical indexes were determined in 506 T2 DM patients and 250 healthy subjects(control group),and urine was collected for the determination of urinary albumin/creatinine ratio(ACR).According to expert consensus on prevention and treatment of diabetic nephropathy(2014 edition),T2 DM patients were divided into DN group(n=279)and non-DN group(n=227),and DN group was furtherly divided into micro albuminuria group(n=165,30-300 mg/24h)and massive albuminuria group(n=114,300 mg/24h)according to ACR.Clinical indicators of each group were compared to analyze the influence of PLR on DN in elderly T2 DM patients.Results:Compared with control group,HbAlc,FPG,2h PG,Scr,BUN,PLT and PLR were significantly increased and LYM was significantly decreased in the non-DN group and the DN group(P<0.05).Compared with the non-DN group,HbAlc,2h PG,Scr,UAER and eGFR were significantly increased in the microalbuminuria group,while HbAlc,FPG,2h PG,Scr,BUN,UAER,eGFR,PLT and PLR were significantly increased and LYM was significantly decreased in the massive albuminuria group(P<0.05).Compared with the microalbuminuria group,FPG,Scr,BUN,UAER,eGFR,PLT and PLR were significantly increased and LYM was significantly decreased in the massive albuminuria group(P<0.05).Multiple logistics regression analysis showed that HbAlc and PLR were independent risk factors for DN in T2 DM patients,while eGFR was a protective factor(P<0.05).The sensitivity and specificity of combined detection of HbAlc,eGFR and PLR to predict DN in T2 DM patients were 83.1%and 81.9%,respectively,which were significantly higher than separate detection(P<0.05).Conclusions:PLR is an independent risk factor for renal impairment in elderly T2 DM patients,and the combination of HbAlc,eGFR and PLR is helpful for DN and disease evaluation in elderly T2 DM patients.