中性粒细胞与淋巴细胞比值对诊断早期2型糖尿病肾病的价值分析

The value analysis of neutrophil to lymphocyte ratio for diagnosing early type 2 diabetic kidney disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)在2型糖尿病并发早期糖尿病肾病(DKD)患者中的变化及应用价值。方法依据预估肾小球滤过率(eGFR)及尿清蛋白与肌酐比值(ACR),将651例2型糖尿病(T2DM)患者分为早期糖尿病肾病(DKD)组376例,无肾病单纯糖尿病(DM)组275例;另选无糖尿病、年龄相近的健康体检者150例作为对照组。比较DKD、DM及对照组的NLR水平以及DKD、DM组各生化指标的水平;研究各检测指标与早期DKD相关性,用Logistic回归分析影响因素,绘制受试者工作特征曲线(ROC曲线),评估NLR对早期DKD的预测能力。结果DKD组、DM组及对照组NLR分别为2.98±0.41、2.37±0.75以及2.01±0.60,C反应蛋白(CRP)水平分别为(8.43±2.79)mg/L、(7.54±2.33)mg/L及(3.71±2.59)mg/L。DKD组、DM组NLR及CRP值显著高于对照组,差异有统计学意义(P<0.05);DM组NLR值、ACR值显著低于DKD组,差异均有统计学意义(P<0.05);DM组CRP值低于DKD组,差异无统计学意义(P>0.05);Logistic回归分析表明,NLR升高是DKD的危险因素(P<0.01,OR=3.016);ROC曲线显示曲线下面积(AUC)=0.803(95%CI:0.770~0.835,P<0.001),NLR对早期DKD有重要诊断价值,当NLR界值取2.675时,其诊断效率最高,灵敏度为51.1%,特异度为86.7%。结论NLR升高是早期DKD的高危因素,对早期DKD有重要诊断价值。

Objective To investigate the change and application value of neutrophil to lymphocyte ratio(NLR)in patients with type 2 diabetes mellitus complicated with early diabetic kidney disease(DKD).Methods According to estimated glomerular filtration rate(eGFR)and urinary albumin to creatinine ratio(ACR),the 651 patients with T2DM were divided into 2 groups:early DKD group(n=376)and non diabetic nephropathy group(n=275).Another 150 healthy persons without diabetes and similar age were selected as control group.The NLR levels of DKD,DM and control groups,and the levels of biochemical indexes of DKD and DM groups were compared.The correlation of detection indexes of early DKD,the influencing factors with logistic regression were analyzed.The receiver operating characteristic curve(ROC curve)was drawed,which was evaluated the prediction ability of NLR to early DKD.Results NLR of DKD,DM and control groups were 2.98±0.41,2.37±0.75 and 2.01±0.60 respectively,and C reactive protein(CRP)were(8.43±2.79)mg/L,(7.54±2.33)mg/L and(3.71±2.59)mg/L respectively.NLR and CRP in DKD group and DM group were significantly higher than those in control group(P<0.05);NLR and ACR in DM group were significantly lower than those in DKD group(P<0.05);CRP in DM group was lower than that in DKD group,and the difference was no significant(P>0.05).Logistic regression analysis showed that elevated NLR was the risk factor of DKD(P<0.01,OR=3.016);ROC curve showed that area under curve were 0.803(95%CI:0.770-0.835,P<0.001),NLR had important diagnostic value for early DKD.When NLR was 2.675,its diagnostic efficiency was the highest.The sensitivity was 51.1%,and the specificity was 6.7%.Conclusion The increase of NLR is a high risk factor and an important diagnostic value for stage DKD.