糖尿病肾脏疾病患者红细胞分布宽度标准差及血小板/淋巴细胞比值与左心室肥厚的相关性研究

Correlation between standard deviation of red blood cell distribution width,platelet/lymphocyte ratio and left ventricular hypertrophy in patients with diabetic kidney disease

目的探讨糖尿病肾脏疾病(diabetic kidney disease,DKD)患者红细胞分布宽度标准差(red blood cell distribution width-standard deviation,RDW-SD)、血小板/淋巴细胞比值(platelet to lymphocyte ratio,PLR)与左心室肥厚(left ventricular hypertrophy,LVH)之间潜在的联系。方法选取2018年10月至2020年9月在昆明医科大学第一附属医院肾脏内科住院的符合临床DKD诊断标准的236例患者作为研究对象,采用彩色多普勒超声检测患者心脏结构改变,根据LVH诊断标准将研究对象分为非LVH组(125例)和LVH组(111例)。比较两组患者一般资料和相关临床实验室指标,采用Spearman相关分析和多因素Logistic回归分析法研究DKD患者合并LVH的危险因素,绘制受试者工作曲线(receiver operating characteristic curve,ROC)分析RDW-SD及PLR对DKD患者LVH的预测价值。结果相关性结果显示:血磷、尿酸、RDW-SD、PLR与左心室质量指数(left ventricular mass index,LVMI)呈正相关(r=0.187、0.149、0.332、0.445,P<0.05),淋巴细胞绝对值、总蛋白、三酰甘油、血钙、估算肾小球滤过率与LVMI呈负相关(r=-0.377、-0.175、-0.234、-0.245、-0.358,P<0.01)。回归分析结果显示:RDW-SD>44%、PLR(per10)是DKD患者合并LVH的独立危险因素,OR值分别为2.417(95%CI 1.356~4.308,P=0.003)、1.190(95%CI 1.117~1.268,P<0.01)。ROC曲线显示:RDW-SD、PLR、RDW-SD联合PLR是DKD患者合并LVH的预测因子(P<0.05),曲线下面积分别为0.777、0.804、0.826。结论DKD患者RDW-SD、PLR水平的升高与LVH显著相关,二者联合可预测DKD患者合并LVH的风险,因此动态监测RDW-SD、PLR对DKD患者预防不良心血管事件的发生有一定临床指导价值。

Objective To explore the potential relationship between standard deviation of red blood cell distribution width(RDW-SD),platelet/lymphocyte ratio(PLR)and left ventricular hypertrophy(LVH)in patients with diabetic kidney disease(DKD).Methods A total of 236 patients fulfilling the clinical diagnostic criteria of DKD were selected as research subjects.The changes of heart structure were detected by color Doppler ultrasound.According to the diagnostic criteria of LVH,they were divided into two groups of non-LVH(n=125)and LVH(n=111).Demographic data and the relevant clinical laboratory parameters of two groups were compared.Spearman’s correlation and multivariate Logistic regression were employed for examining the risk factors of DKD patients complicated with LVH,And receiver operating curve(ROC)was plotted for analyzing the predictive value of RDW-SD or PLR for LVH in DKD patients.Results Correlation results indicated that serum phosphorus,uric acid,RDW-SD and PLR were positively correlated with left ventricular mass index(LVMI)(r=0.187,0.149,0.332,0.445,P<0.05);lymphocyte absolute value,total protein,triglyceride,serum calcium and glomerular filtration rate were negatively correlated with LVMI(r=-0.377,-0.175,-0.234,-0.245,-0.358,P<0.01).Regression analysis showed that RDW-SD>44%and PLR(per10)were independent risk factors for DKD patients with LVH.OR values were 2.417(95%CI 1.356-4.308,P=0.003)and 1.190(95%CI1.117~1.268,P<0.01).ROC curve indicated that RDW-SD,PLR,RDW-SD plus PLR were the predictors of LVH in DKD patients(P<0.05)and the area under the curve(AUC)were 0.777,0.804 and0.826 respectively.Conclusions Elevations of RDW-SD and PLR are significantly correlated with LVH and the combination of two parameters can predict the risk of LVH in DKD patients.Therefore dynamic monitoring of RDW-SD and PLR offers clinical guidance for preventing adverse cardiovascular events.