甲状旁腺切除术对肾性继发性甲状旁腺功能亢进患者NLR、PLR的影响

Effect of parathyroidectomy on NLR and PLR in patients with renal secondary hyperparathyroidism

目的探讨甲状旁腺切除术对肾性继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)的影响,及NLR、PLR与贫血、血钙、血磷间的关系。方法选取2013年1月至2019年1月在安徽医科大学第二附属医院肾脏内科行甲状旁腺切除术的151例肾性SHPT患者。术后根据全段甲状旁腺素(intact parathyroid hormone,iPTH)水平分为手术成功组和持续性SHPT或复发性SHPT组,比较两组术后NLR、PLR等指标的变化。结果相关性分析提示术前NLR与白细胞计数、超敏C反应蛋白、血磷、钙磷乘积呈正相关(P<0.05)。术前PLR与血磷、钙磷乘积呈正相关(P<0.05),与血红蛋白呈负相关(P<0.05)。手术成功组中,与术前相比,血钙、血磷、NLR、PLR、iPTH明显下降,血红蛋白、红细胞计数、淋巴细胞计数较术前明显升高(P<0.05)。持续性SHPT或复发性SHPT组中,术后血钙、iPTH较术前下降(P<0.05),而NLR、PLR、血红蛋白等指标手术前后比较差异无统计学意义(P>0.05)。多因素回归分析结果显示术前NLR、PLR可分别预测手术前后NLR变化量、PLR变化量。结论成功的甲状旁腺切除术可以降低NLR和PLR,通过对全身炎症的调节作用,可能在一定程度上改善肾性SHPT患者的贫血及矿物质和骨代谢异常。

Objective To explore the effects of parathyroidectomy on neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in patients with renal secondary hyperparathyroidism(SHPT).Also the correlation was made between NLR、PLR and anemia,calcium and phosphorus,which provides clinical basis for improving anemia,mineral and bone disorder(MBD)and quality-of-life in SHPT patients.Methods A total of 151 patients with renal SHPT undergoing parathyroidectomy from January 2013 to January 2019 were recruited.According to the postoperative level of intact parathyroid hormone(iPTH),they were divided into two groups of successful and persistent or recurrent SHPT.The postoperative changes of NLR/PLR and other parameters were compared between two groups.Results Spearman’s correlation analysis indicated that preoperative NLR was positively correlated with white blood cell count,hypersensitive C-reactive protein,phosphorus,calcium and phosphorus product(P<0.05).Preoperative PLR was correlated positively with phosphorus,serum calcium and phosphorus product(P<0.05)and negatively with hemoglobin(P<0.05).In successful group,as compared preoperatively,serum levels of calcium,phosphorus,NLR/PLR,platelet count and iPTH decreased markedly while hemoglobin,red blood cell count and lymphocyte count rose obviously(P<0.05).In persistent or recurrent SHPT group,postoperative serum levels of calcium and iPTH decreased as compared preoperatively(P<0.05).No statistically significant difference existed in NLR/PLR,hemoglobin or other parameters before and after operation(P>0.05).Multi-factorial regression analysis revealed that preoperative NLR/PLR could predict the variations of NLR(ΔNLR)and PLR(ΔPLR).Conclusions Successful parathyroidectomy decreases NLR/PLR.And the modulatory effects of parathyroidectomy on systemic inflammation may improve the symptoms of anemia and MBD in patients with renal SHPT.