控制营养状态评分和血小板/淋巴细胞比值与腹膜透析患者左心室肥厚的关系

Control nutritional status score and platelet/lymphocyte ratio relationship with left ventricular hypertrophy in peritoneal dialysispatients

目的应用控制营养状态(controlling nutritional status,CONUT)评分和血小板/淋巴细胞比值(platelet to lymphocyte ratio,PLR)评估腹膜透析(peritoneal dialysis,PD)患者营养状态和炎症水平,并分析其与左心室肥厚(left ventricular hypertrophy,LVH)的关系。方法纳入2019年1月至2020年5月在徐州医科大学附属医院肾内科接受PD治疗的患者。收集患者一般资料、实验室指标,应用心脏彩色多普勒超声评估患者心脏结构改变。根据是否存在LVH,分为LVH组和非LVH组,比较两组间各指标差异;用Logistic回归法分析患者发生LVH的危险因素;用ROC曲线分析PLR、CONUT对腹膜透析患者发生LVH的预测能力。结果(1)本研究共纳入82例患者,LVH发生率为40.2%,LVH组的收缩压、尿酸、PLR、CONUT评分均高于非LVH组,血红蛋白、左心室射血分数、白蛋白均低于非LVH组(P<0.05),差异均有统计学意义。(2)Logistic回归分析显示:收缩压、PLR、CONUT评分均为LVH发生的影响因素。(3)经ROC曲线分析发现,PLR、CONUT评分预测PD患者LVH的曲线下面积分别为0.743、0.822,联合预测价值为0.855。结论CONUT评分和PLR与PD患者发生LVH具有相关性,是LVH发生的影响因素,CONUT评分及PLR联合预测PD患者LVH的价值更高。

Objective Using controlling nutritional status(CONUT)score and platelet to lymphocyte ratio(PLR),to evaluate the nutritional status and inflammation status of patients with peritoneal dialysis(PD),and analyze their relationship with left ventricular hypertrophy.Methods The patients undergoing peritoneal dialysis in Department of Nephrology,Affiliated Hospital of Xuzhou Medical University from January 2019 to May 2020 were enrolled.General patient information and laboratory indicators were collected.Cardiac color Doppler ultrasound was used to assess changes in the patient's cardiac structure.According to the presence or absence of left ventricular hypertrophy(LVH),the patients were divided into LVH group and non-LVH group.Each indicator was compared between the two groups,and risk factors of LVH were analyzed by logistic regression method.ROC curve was used to analyze the sensitivity and specificity of PLR and CONUT in diagnosing LVH.Results(1)A total of 82 patients were included,and the incidence of LVH was 40.2%.Systolic blood pressure,uric acid,PLR and CONUT scores of the LVH group were significantly higher than those of the non-LVH group;and Hb,LVEF and Alb were significantly lower than those of the non-LVH group(P<0.05),with statistical significance.(2)Logistic regression analysis showed that systolic blood pressure,PLR and CONUT score were all risk factors affecting left ventricular hypertrophy.(3)The areas under the curve of LVH ROC curve analysis found that,the areas under the curve of LVH PLR and CONUT score predicted in PD patients were 0.743 and 0.822,respectively,and the combined prediction value was 0.855.Conclusions CONUT score and PLR are associated with LVH in peritoneal dialysis patients,and are the influencing factors of LVH.The combination between CONUT score and PLR is more valuable in predicting LVH in PD patients.