中性粒细胞淋巴细胞比值、营养状态与血液透析患者腹主动脉钙化的相关性分析

Analysis of the relationship between neutrophils-to-lymphocytes ratio,nutritional status and abdominal aortic calcification in hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者中性粒细胞淋巴细胞比值(neutrophils-to-lymphocytes ratio,NLR)、营养状态与腹主动脉钙化(abdominal aortic calcification,AAC)的关系,同时分析影响AAC的危险因素。方法选取2019至2020年在徐州医科大学附属医院血液净化中心治疗的MHD患者。收集患者的一般临床资料及实验室检查结果,用腹部侧位X线平片检查患者AAC的情况。老年营养风险指数(geriatric nutritional risk index,GNRI)评估患者营养状况。根据是否发生腹主动脉钙化将患者分为非钙化组和钙化组。比较两组间各指标的差异,采用二元Logistic回归分析法探讨AAC发生的危险因素。结果共纳入72例MHD患者,钙化组37例,非钙化组35例。与非钙化组相比,钙化组年龄、糖尿病患病率、甲状旁腺激素(parathyroid hormone,PTH)、C反应蛋白(C-creative protein,CRP)、NLR均明显升高(t/Z/χ^(2)值分别为3.194,4.766,2.698,2.587,2.943;P值分别为0.002,0.029,0.007,0.010,0.004),白蛋白(Z=﹣2.947,P=0.003)、GNRI(χ^(2)=﹣2.475,P=0.016)明显降低。Spearman相关性分析显示AAC与年龄、PTH、NLR、CRP呈正相关(r值分别为0.343,0.320,0.307,0.293;P值分别为0.003,0.006,0.009,0.010),与白蛋白(r=-0.350,P=0.003)、GNRI(r=-0.263,P=0.026)呈负相关。Logistic回归分析发现:年龄(OR=1.077,95%CI:1.017~1.141,P=0.012)、糖尿病(OR=4.545,95%CI:1.032~20.007,P=0.045)、NLR(OR=2.463,95%CI:1.317~4.608,P=0.005)为AAC的危险因素,白蛋白水平升高则为AAC的保护性因素(OR=0.870,95%CI:0.771~0.982,P=0.024)。结论NLR及营养不良与MHD患者AAC相关。年龄、糖尿病、白蛋白水平及NLR是AAC的独立危险因素。

Objective To investigate the relationship between neutrophils-lymphocytes ratio(NLR),nutritional status and abdominal aortic calcification(AAC)in maintenance hemodialysis(MHD)patients,and to analyze the risk factors of AAC.Methods MHD patients treated in the Blood Purification Center of the Affiliated Hospital of Xuzhou Medical University from 2019 to 2020 were selected.The clinical data and laboratory examination results of patients were collected,and the AAC of patients was examined by abdominal lateral X-ray film.The geriatric nutritional risk index(GNRI)was used to evaluate patients’nutritional status.According to whether abdominal aortic calcification occured,the patients were divided into non-calcification group and calcification group.The differences of indices between the two groups were compared,and binary Logistic regression analysis was used to explore the risk factors of AAC.Results A total of 72 patients with MHD were included,divided into calcification group(n=37)and non-calcification group(n=35).Compared with the non-calcified group,patients in calcification group were older,with higher proportion of diabetes mellitus,and with higher parathyroid hormone(PTH),C-creative protein(CRP)and NLR,lower albumin,GNRI(P<0.05).Correlation analysis showed that AAC was positively correlated with age,PTH,CRP and NLR,but negatively correlated with Alb and GNRI(P<0.05).Logistic regression analysis showed that age,diabetes mellitus,lower albumin and higher NLR were independent risk factors for abdominal aortic calcification. Conclusions NLR and malnutrition status are associated with AAC in patients with MHD. Old age, diabetesmellitus, lower albumin and higher NLR are independent risk factors for abdominal aortic calcification.