单核细胞/高密度脂蛋白比值与慢性肾脏病疾病严重程度及预后的关系

Relationship between monocyte/high-density lipoprotein ratio and severity and prognosis of chronic kidney disease

目的:探讨单核细胞/高密度脂蛋白比值(monocyte/high-density lipoprotein ratio,MHR)与慢性肾脏病(chronic kidney disease,CKD)患者临床参数及预后的关系。方法:收集自2017年1月1日至2020年6月30日于河南省人民医院确诊并规律随访的CKD患者的临床资料,按照入选患者基线MHR中位数分为两组:低水平MHR组(MHR≤0.3478)和高水平MHR组(MHR>0.3478)。规律随访3~42个月,肾脏不良预后事件定义为血肌酐翻倍、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)至少降为原来的1/2、新进入终末期肾病(end-stage renal disease,ESRD)、接受肾脏替代治疗、肾脏或心血管事件原因死亡,采用Kaplan-Meier法比较两组患者肾脏累积生存率的差异,Cox回归分析法探讨与CKD患者肾脏不良预后相关的影响因素,分层分析寻找可能影响MHR与肾脏不良预后关系的因素。结果:共405例患者被纳入本研究,年龄为(49.77±14.82)岁,体重指数为(25.18±4.22)kg/m_(2),女性占30.62%(124/405),吸烟者、饮酒者、合并高血压和糖尿病者分别占39.51%(160/405)、35.06%(142/405)、73.33%(297/405)和38.27%(155/405)。与低水平MHR组(n=202)相比,高水平MHR组(n=203)CKD晚期人数、男性人数、患高血压人数较多(均P<0.01),体重指数、白细胞、单核细胞、血肌酐、血尿酸、血尿素氮、视黄醇结合蛋白、胱抑素C、血磷较高(均P<0.05),而血红蛋白、高密度脂蛋白、eGFR较低(均P<0.05)。Spearman秩相关分析结果显示MHR水平与白细胞、血肌酐、血尿酸、血尿素氮、视黄醇结合蛋白、胱抑素C、血磷呈正相关(均P<0.01),与血红蛋白、eGFR呈负相关(均P<0.01)。中位随访时间为8(4,16)个月,至随访终点,共113例(27.90%)患者发生肾脏不良预后事件。Kaplan-Meier生存分析结果显示,与低水平MHR组相比,高水平MHR组肾脏累积生存率较低(χ^(2)=8.277,P=0.004)。多因素Cox回归分析结果显示高水平MHR是CKD患者肾脏不良预后的独立影响因素(HR=1.628,95%CI 1.050~2.523,P=0.029)。分层分析显示,不合并高血压时,MHR对肾脏不良预后的影响更为显著(HR=3.414,95%CI 1.091~10.686,交互作用P=0.001)。结论:MHR水平与CKD的严重程度及肾脏不良预后相关,高水平MHR可能是CKD患者肾脏不良预后的独立预测因素。

Objective To investigate the relationship between monocyte/high-density lipoprotein ratio(MHR)and clinical parameters and the prognosis of patients with chronic kidney disease(CKD).Methods Clinical data were collected of CKD patients who were diagnosed and followed up regularly in Henan Provincial People's Hospital from January 1,2017 to June 30,2020.According to the median baseline MHR of the selected patients,they were divided into two groups:low-level MHR group(MHR≤0.3478)and high-level MHR group(MHR>0.3478).The patients were regularly followed up for 3-42 months,the renal adverse prognostic events were defined as serum creatinine doubled,estimated glomerular filtration rate(eGFR)reduced to at least 50%of the original,new entry into end-stage renal disease(ESRD),starting renal replacement therapy,death due to renal or cardiovascular events.The Kaplan-Meier method was used to compare the differences in survival rates between the two groups,and Cox regression analysis method was used to explore the influencing factors of renal adverse prognosis in CKD patients.Stratified analysis was used to find special factors that might affect the relationship between MHR and renal adverse prognosis in CKD patients.Results A total of 405 patients were included in this study.Their age was(49.77±14.82)years old.Body mass index was(25.18±4.22)kg/m_(2).Women accounted for 30.62%(124/405).The proportion of patients with smoking,drinking,hypertension and diabetes was 39.51%(160/405),35.06%(142/405),73.33%(297/405)and 38.27%(155/405),respectively.Compared with the low-level MHR group(n=202),the high-level MHR group(n=203)had more people in late CKD,males,and hypertension(all P<0.01),and body mass index,white blood cells,monocytes,serum creatinine,serum uric acid,serum urea nitrogen,retinol binding protein,cystatin C,blood phosphorus were higher(all P<0.05),while hemoglobin,high density lipoprotein and eGFR were lower(all P<0.05).Spearman rank correlation results show that MHR level was positively correlated with white blood cells,serum creatinine,serum uric acid,serum urea nitrogen,retinol-binding protein,cystatin C,serum phosphorus(all P<0.01),and negatively correlated with hemoglobin and eGFR(both P<0.01).The median follow-up time was 8(4,16)months.To the end of the follow-up,113 patients(27.90%)had renal adverse prognostic events.Kaplan-Meier survival analysis results showed that the renal cumulative survival rate of the high-level MHR group was lower than that of the low-level MHR group(χ^(2)=8.277,P=0.004).Multivariate Cox regression analysis showed that high MHR level was an independent influencing factor for poor renal prognosis in CKD patients(HR=1.628,95%CI 1.050-2.523,P=0.029).Stratified analysis showed that,without hypertension,MHR had a more significant effect on the prognosis of the kidneys(HR=3.414,95%CI 1.091-10.686,P for interaction=0.001).Conclusions The level of MHR is related to the severity and poor renal prognosis of CKD,and the high MHR level is an independent predictor for poor renal prognosis in CKD patients.