中性粒淋巴细胞比在评估维持性血液透析患者腹主动脉钙化及预后中的作用

Role of neutrophil-lymphocyte ratio in evaluating abdominal aortic calcification and prognosis in maintenance hemodialysis patients

目的近年来,研究发现中性粒淋巴细胞比(neutrophil-lymphocyte ratio,NLR)与多种疾病的心血管事件和预后相关,但在维持性血液透析(maintenance hemodialysis,MHD)患者中的研究较少。因此,本研究旨在探讨NLR与MHD患者腹主动脉钙化(abdominal aortic calcification,AAC)及预后的关系。方法收集115例MHD患者一般情况与临床指标,利用腹部侧位X线平片评估患者AAC情况,根据腹主动脉钙化评分(abdominal aortic calcification score,AACS)分为无或轻度钙化组(AACS<5)和中重度钙化组(AACS≥5)。采用Logistic回归法分析MHD患者中重度AAC危险因素,Kaplan Meier法分析不同水平NLR患者生存率差异,COX比例风险模型分析MHD患者全因死亡及心血管疾病(cardiovascular disease,CVD)死亡危险因素。结果115例MHD患者平均年龄(57.8±13.9)岁,中位透析龄82.0(29.0,122.0)m,中位AACS4.0(0.0,11.0)分,其中无或轻度钙化组62例(53.9%),中重度钙化组53例(46.1%)。Logistic回归分析显示高NLR水平是MHD患者发生中重度AAC的独立危险因素。中位随访时间72(68,75)m,其中全因死亡23例(20%),CVD死亡17例(14.8%)。Kaplan Meier分析结果显示,高NLR水平患者全因死亡率(χ^(2)=4.219,P=0.040)和CVD死亡率(χ^(2)=5.383,P=0.020)均显著高于低NLR水平MHD患者。多因素COX回归分析结果显示,NLR是MHD患者全因死亡(HR=1.191,95%CI 1.033~1.372,P=0.016)和CVD死亡(HR=1.212,95%CI 1.015~1.448,P=0.034)的独立危险因素。结论NLR可以作为MHD患者发生中重度腹主动脉钙化、全因死亡及CVD死亡的独立预测因子。

Objective The purpose of this study was to investigate the relationship between neutrophillymphocyte ratio(NLR)and abdominal aortic calcification(AAC)and prognosis in maintenance hemodialysis(MHD)patients.Methods The general conditions and clinical indexes of 115 MHD patients were collected.AAC was evaluated by abdominal lateral X-ray plain film.According to the abdominal aortic calcification score(AACS),the patients were divided into no or mild calcification group and moderate to severe calcification group.Logistic regression was used to analyze the risk factors of moderate to severe AAC in MHD patients.Kaplan-Meier survival method was used to analyze the difference of survival rate in patients with different levels of NLR,and COX proportional hazards model was used to analyze the risk factors of all-cause death and cardiovascular death in MHD patients.Results The mean age of 115 MHD patients was 57.8±13.9 years,the median dialysis vintage was 82.0(29.0,122.0)months,and the median AACS was 4.0(0.0,11.0).There were 62 cases(53.9%)in the non or mild calcification group and 53 cases(46.1%)in the moderate to severe calcification group.Logistic regression analysis showed that high NLR level was an independent risk factor for moderate to severe AAC.The median follow-up time was 72(68,75)months.At the end of follow-up,there were 23 all-cause deaths(20%),including 17 CVD deaths(14.8%).Kaplan-Meier analysis showed that all-cause death and cardiovascular death in patients with high NLR level were significantly higher than those with low NLR level(all-cause mortality:χ^(2)=4.219,P=0.040;cardiovascular death:χ^(2)=5.383,P=0.020).Multivariate COX regression analysis showed that NLR was an independent risk factor for allcause death and CVD death in MHD patients(all-cause death:HR=1.191,95%CI:1.033~1.372,P=0.016;cardiovascular death:HR=1.212,95%CI:1.015~1.448,P=0.034).Conclusions NLR can be used as an independent predictor of moderate to severe AAC,all-cause death and cardiovascular death in MHD patients.