外周血中性粒细胞与淋巴细胞比值对慢性肾病4期进展的预测价值

Predictive value of peripheral blood neutrophil-to-lymphocyte ratio for progression of stage 4chronic kidney disease

背景慢性肾病(chronic kidney disease,CKD)已经成为全球性的健康问题,延缓病情进程尤为重要,外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)作为新型炎症指标,在预测CKD进展方面的研究较少。目的分析外周血NLR对慢性肾病4期(CKD 4期)病情进展的预测价值。方法本研究为单中心回顾性研究,研究对象为2018年12月-2019年12月河北大学附属医院肾病科收治的CKD 4期住院患者。收集患者人口学、临床资料以及随访数据,研究终点事件为开始肾替代治疗或进展至CKD 5期。根据全部研究对象NLR中位数将入组患者分为高NLR组(high NLR group,HG)和低NLR组(low NLR group,LG),并对两组临床特点进行比较。通过多因素Cox回归模型分析CKD 4期患者病情进展的影响因素。结果最终纳入研究对象218例,平均年龄为(60.8±4.46)岁,其中男性117例(53.7%);平均随访期为19.3个月,在此期间有39.6%的患者达到研究终点。与LG组比较,HG组达到研究终点人数多(62.4%vs 33.6%,P=0.013),有高血压病史者比例更高(87.1%vs 73.2%,P=0.009),人血白蛋白较低[(3.75±0.43)g/dL vs(3.93±0.47)g/dL,P=0.001],平均C反应蛋白较高[(18.1±11.2)mg/L vs(7.9±4.4)mg/L,P<0.001];Kaplan–Meier生存分析显示,HG显著降低平均肾存活率(9个月vs 15个月,P<0.001);多因素Cox回归模型结果显示,NLR对研究终点影响最为显著[HR(95%CI)=2.832(2.174~5.836),P=0.001]。结论NLR是预测肾终点的独立指标,可以很好地反映CKD 4期患者预后。

Background Chronic kidney disease(CKD)has become a global health problem,how to delay the progression of the disease is of great importance.As a new inflammatory indicator,peripheral blood neutrophil/lymphocyte ratio(NLR)is rarely studied in predicting the progression of CKD.Objective To analyze the value of neutrophil-to-lymphocyte ratio in predicting the progression of stage 4 chronic kidney disease.Methods This was a single center retrospective study.Patients with stage 4 chronic kidney disease in nephrology department of Affiliated Hospital of Hebei University were included from December 2018 to December 2019.Demographic,clinical data and follow-up data were collected.The end point of the study was the initiation of renal replacement therapy(RRT)or progression to CKD5.All the patients were divided into HG group and LG group according to the median neutrophil-to-lymphocyte,and the clinical characteristics were compared between the two groups.Multivariate Cox regression model was used to analyze the influencing factors of disease progression in stage 4 chronic kidney disease.Results A total of 218 subjects were included,with an average age of(60.8±4.46)years,including 117 males(53.7%).The average follow-up period was 19.3 months,during which 39.6%of the patients reached to the study endpoint.Compared with LG group,more patients in HG group reached the end point(62.4%vs 33.6%,P=0.013)and had a history of hypertension(87.1%vs 73.2%,P=0.009),patients in HG group had lower serum albumin([3.75±0.43]g/dL vs[3.93±0.47]g/dL,P=0.001),and higher CRP([18.1±11.2]mg/L vs[7.9±4.4]mg/L,P<0.001).Kaplan Meier survival analysis showed that the mean renal survival reduced significantly in HG patients(9 months vs 15 months,P<0.001).Multivariate Cox regression model showed that the neutrophil-to-lymphocyte ratio had the most significant effect on the study endpoint(HR[95%CI]=2.832[2.174-5.836],P=0.001).Conclusion Neutrophil-tolymphocyte ratio is an independent index to predict the renal end point,which can well reflect the prognosis of patients with stage 4 chronic kidney disease.