肾功能正常的2型糖尿病患者中性粒细胞/淋巴细胞比值与尿白蛋白/肌酐比值的关系

Relationship between neutrophil to lymphocyte ratio and urinary albumin to creatinine ratio in type 2 diabetes mellitus patients with normal renal function

目的探讨肾功能正常的2型糖尿病(T_(2)DM)患者中性粒细胞/淋巴细胞比值(NLR)与尿白蛋白/肌酐比值(UACR)的关系。方法回顾性分析2019年9月至2020年8月于中国科学技术大学附属第一医院内分泌科住院的371例肾功能正常的T_(2)DM患者的临床资料,根据UACR水平将其分为UACR正常组(UACR<30 mg/g,264例)和UACR升高组(UACR≥30 mg/g,107例),其中UACR升高组患者又分为UACR轻度升高组(UACR为30~<300 mg/g,91例)和UACR重度升高组(UACR≥300 mg/g,16例)。收集患者的临床资料,采用多因素Logistic回归模型分析肾功能正常的T_(2)DM患者UACR升高的危险因素,受试者工作特征(ROC)曲线评估NLR对UACR升高的预测价值。结果UACR升高组病程、收缩压、糖化血红蛋白(Hb A1c)、NLR、血尿酸水平及吸烟史比例均高于UACR正常组,差异均有统计学意义(均P<0.05)。UACR重度升高组病程、收缩压、Hb A1c、NLR、总胆固醇水平均高于UACR轻度升高组[(13±4)年比(10±3)年、(145±21)mmHg(1 mmHg=0.133 kPa)比(134±14)mmHg、(10.6±2.5)%比(9.3±2.4)%、(2.9±1.6)比(2.2±1.1)、(5.0±1.1)mmol/L比(4.4±1.0)mmol/L],差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,病程、收缩压、Hb A1c、NLR、血尿酸、吸烟史均为UACR升高的危险因素;病程、收缩压、Hb A1c、NLR为UACR重度升高的危险因素(均P<0.05)。ROC曲线分析结果显示,NLR预测UACR升高的曲线下面积为0.842(95%置信区间:0.793~0.892),截断值为2.125,敏感度为82.7%,特异度为76.6%。结论NLR是肾功能正常的T_(2)DM患者UACR升高的危险因素,NLR对UACR升高有良好的预测价值。

Objective To explore the relationship between neutrophil to lymphocyte ratio(NLR)and urinary albumin to creatinine ratio(UACR)in type 2 diabetes mellitus(T_(2)DM)patients with normal renal function.Methods The clinical data of 371 inpatients of T_(2)DM with normal renal function admitted to Department of Endocrinology,the First Affiliated Hospital of USTC from September 2019 to August 2020 were retrospectively analyzed.According to the UACR level,they were divided into UACR normal group(UACR<30 mg/g,264 cases)and UACR increased group(UACR≥30 mg/g,107 cases),and patients in UACR increased group were divided into UACR mildly increased group(UACR as 30-<300 mg/g,91 cases)and UACR severely increased group(UACR≥300 mg/g,16 cases).The clinical data of patients were recorded.Multivariate Logistic regression model was used to analyze the risk factors of UACR increase in T_(2)DM patients with normal renal function.The receiver operating characteristic(ROC)curve was used to evaluate the value of NLR in predicting UACR increased.Results The course of disease,systolic blood pressure(SBP),glycosylated hemoglobin(HbA1c),NLR,serum uric acid levels and history of smoking in UACR increased group were higher than those in UACR normal group(all P<0.05).The course of disease,SBP,HbA1c,NLR and total cholesterol levels in UACR severely increased group were higher than those in UACR mildly increased group[(13±4)years vs(10±3)years,(145±21)mmHg vs(134±14)mmHg,(10.6±2.5)%vs(9.3±2.4)%,(2.9±1.6)vs(2.2±1.1),(5.0±1.1)mmol/L vs(4.4±1.0)mmol/L](all P<0.05).Multivariate Logistic regression analysis showed that course of disease,SBP,HbA1c,NLR and serum uric acid were risk factors for UACR increased;course of disease,SBP,HbA1c and NLR were risk factors for UACR severely increased(all P<0.05).The ROC curve analysis showed that the area under the curve for NLR to predict UACR increased was 0.842(95%confidence interval:0.793-0.892),cut-off value was 2.125,sensitivity was 82.7%and specificity was 76.6%.Conclusion For T_(2)DM patients with normal renal function,NLR is a risk factor for UACR increase.The NLR has a good predictive value for UACR increase.