维持性血液透析患者中性粒细胞/淋巴细胞比值与左心室肥厚的关系

Relationship between neutrophil/lymphocyte ratio and left ventricular hypertrophy in maintenance hemodialysis patients

目的检测维持性血液透析(maintenance hemodialysis,MHD)患者中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)水平,探讨其与左心室肥厚(left ventricular hypertrophy,LVH)相关性。方法选择2018年1月至2019年8月于凉山州第一人民医院肾脏内科行MHD患者96例,获取所有患者NLR中位数并将其分为高NLR组(NLR>3.31,n=47)和低NLR组(NLR≤3.31,n=49),比较2组基线资料、心脏超声指标[左房舒张末内径(LAEDd)、左室收缩末内径(LVEDs)、射血分数(EF)、左心室质量指数(LVMI)]、实验室检测指标[NLR、脑钠肽、Hb、白蛋白(Alb)、血钙]、血脂水平,统计LVH发生率;根据是否发生LVH分为LVH组和非LVH组,多因素分析LVH发生高危因素,ROC曲线分析NLR对LVH发生的预测价值。结果NLR与SBP、LAEDd、LVEDs、LVMI、NLR、BNP、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr均呈正相关(P<0.05),与DBP呈负相关(P<0.05)。经彩色多普勒超声检查结果确定高NLR组LVH发生率高于低NLR组LVH发生率;年龄、SBP、LAEDd、LVEDs、LVMI、NLR、脑钠肽、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr是LVH发生高危因素(P<0.05),且NLR相对危险比(OR)最大。NLR是预测LVH发生的预测因子(P<0.05)。结论NLR值与MHD患者LVH的发生和发展密切相关,关注NLR变化对防治LVH具有较高价值。

Objective To detect the neutrophil/lymphocyte ratio levels in maintenance hemodialysis(MHD)patients,and investigate their relationship with left ventricular hypertrophy(LVH).Methods A total of 96 patients undergoing MHD in Department of Nephrology of the First Hospital of Liangshan Prefecture from January 2018 to August 2019 were selected and divided into the high NLR group(NLR>3.31,n=47)and the low NLR group(NLR≤3.31,n=49).Baseline data,echocardiographic indexes[left atrial end-diastolic diameter(LAEDd),left ventricular end-systolic diameter(LVEDs),ejection fraction(EF),left ventricular mass index(LVMI)],laboratory indexes[NLR,brain natriuretic peptide(BNP),hemoglobin(HB),albumin(Alb),calcium)],blood lipid levels were compared to calculate the LVH incidence.All the patients were divided into LVH group and non LVH group according to whether LVH occurred or not.The high risk factors of LVH were analyzed by multivariate analysis,and the predictive value of NLR to LVH was analyzed by ROC curve.Results NLR was positively correlated with SBP,LAEDd,LVEDs,LVMI,NLR,BNP,Alb,LDL-C,Cholesterol,non-HDL-C,and Cr(P<0.05),and negatively correlated with DBP(P<0.05).The color Doppler ultrasonography indicated that the incidence of LVH in the high NLR group was higher than that in the low NLR group.Age,SBP,LAEDd,LVEDs,LVMI,NLR,BNP,Alb,LDL-C,TC,non-HDL-C,Cr were risk factors for LVH(P<0.05).The relative oddratio(OR)of NLR was the largest.NLR was a predictor of LVH(P<0.05).Conclusions NLR value is closely related to the occurrence and progression of LVH in MHD patients,so the monitoring of the NLR changes has significant value in the prevention and treatment of LVH.