特发性膜性肾病患者外周血中性粒细胞-淋巴细胞比值的临床与病理价值分析

Clinical and Pathological Value of Peripheral Blood Neutrophil-to-Lymphocyte Ratio in Patients with Idiopathic Membranous Nephropathy

目的:探讨外周血中性粒细胞与淋巴细胞比值(NLR)在特发性膜性肾病(IMN)中的临床及病理价值。方法:收集2017年1月至2019年12月确诊为IMN患者221例作为IMN组,将2019年7月至2019年9月体检且尿常规和肾功能指标正常的87例健康体检者作为正常对照组,计算每个研究对象的NLR值,比较两组间NLR值的差异。记录IMN患者的血生化指标及患者的肾脏病理分期及纤维化程度,并且根据MDRD公式计算肾小球滤过率(eGFR),分析NLR与IMN患者的血生化指标及病理特征的相关性。ROC曲线分析外周血NLR评估IMN患者肾间质纤维化的敏感性和特异性。结果:IMN组外周血NLR值高于对照组,差异有统计学意义(P<0.05)。外周血NLR值与IMN患者年龄和肾间质纤维化有关联(P均<0.05),但与IMN患者性别及肾脏病理分期无关联(P均>0.05)。IMN外周血NLR值与IMN患者hs-CRP、SCr、BUN呈正相关(P<0.05),与eGFR呈负相关(P<0.05),与ESR、UA、TP、Alb、24小时蛋白尿定量均无相关性(P均>0.05)。不同程度肾间质纤维化的IMN患者外周血NLR值不同,差异有统计学意义(P<0.05),且肾间质纤维化程度在1、2、3级时,纤维化程度越重,NLR值越大;3个级别间两两比较,差异均有统计学意义(P均<0.05)。外周血NLR值预测IMN患者肾间质纤维化的ROC曲线下面积为0.715[95%CI(0.626,0.803)],其截断值为1.858时,灵敏度为68.6%,特异度为66.7%。结论:外周血NLR可作为IMN肾脏功能水平的一个有效评价指标,且与IMN患者肾间质纤维化有关,可作为判断肾间质纤维化的参考指标。

Objective:To investigate the clinical and pathological value of peripheral blood Neutrophil-to-Lymphocyte Ratio(NLR)in idiopathic membranous nephropathy(IMN).Methods:221 patients with IMN diagnosed from January 2017 to December 2019 were selected as IMN group,and 87 healthy people with normal urine routine and renal function indexes from July 2019 to September 2019 were selected as the normal control group.The NLR value of each research object was calculated,and the difference of NLR value between the two groups was compared.The blood biochemical indexes,renal pathological stage and fibrosis degree of IMN patients were recorded,and glomerular filtration rate(eGFR)was calculated according to MDRD formula,and the correlation between NLR and blood biochemical indexes and pathological characteristics of IMN patients was analyzed.ROC curve was used to analyze the sensitivity and specificity of NLR in evaluating renal interstitial fibrosis of IMN patients.Results:The NLR value of peripheral blood in IMN group was higher than that in control group(P<0.05).Peripheral blood NLR was associated with age and renal interstitial fibrosis(all P<0.05),but not with gender and renal pathological stage(all P>0.05).The value of NLR in peripheral blood of IMN was positively correlated with hs-CRP,SCr and BUN(P<0.05),and negatively correlated with eGFR(P<0.05),but no correlation with ESR,UA,TP,Alb and 24 h urine protein quantification(P>0.05).The NLR values of peripheral blood of IMN patients with different degrees of renal interstitial fibrosis were different,the difference was statistically significant(P<0.05),and the degree of renal interstitial fibrosis in Grade 1,2,3,the more serious the degree of fibrosis,the greater the NLR value;the differences were statistically significant between the three levels of IMN(all P<0.05).The area under ROC curve was 0.715[95%CI(0.626,0.803)],and the sensitivity and specificity were 68.6%and66.7%respectively when the cut-off value was 1.858.Conclusion:Peripheral blood NLR can be used as an effective index to evaluate renal function in IMN patients,and it is related to renal interstitial fibrosis in patients with IMN.