MLR、MPV与2型糖尿病患者肾小管损伤的相关性研究

Association between Monocyte-to-lymphocyte Ratio or Mean Platelet Volume and Renal Tubular Injury in Type 2 Diabetes Mellitus Patients

目的探讨单核细胞/淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)和平均血小板体积(mean platelet volume,MPV)与2型糖尿病(type 2 diabetes mellitus,T2DM)患者肾小管损伤的相关性。方法收集住院治疗的278例T2DM患者,根据尿白蛋白/肌酐比值(UACR)分为正常白蛋白尿组(UACR<30mg/g)、微量白蛋白尿组(30mg/g≤UACR<300mg/g)和大量白蛋白尿组(UACR≥300mg/g);根据MLR四分位数分为4组(Q_(1)~Q_(4)组);根据MPV四分位数分为4组(Q_(1)′~Q_(4)′组)。收集患者一般临床资料并进行血常规、生化检查、尿液检查。计算MLR、估算的肾小球滤过率(eGFR)、尿α_(1)微球白蛋白/肌酐比值(α_(1)CR),以α_(1)CR作为反映肾小管损伤的指标。采用Spearman相关分析法分析MLR、MPV与肾损伤标志物的相关性,采用受试者工作特征(ROC)曲线分析MLR、MPV对肾小管损伤的预测价值。结果正常白蛋白尿组、微量白蛋白尿组、大量白蛋白尿组MLR、MPV水平依次升高,差异有统计学意义(P均<0.05)。随着MLR、MPV四分位数升高,UACR、α_(1)CR逐渐升高,差异有统计学意义(P均<0.05),Spearman相关性分析显示,MLR、MPV与UACR、α_(1)CR均呈正相关(r分别为0.353、0.367;0.348、0.357,P均<0.01),与eGFR呈负相关(r分别为-0.337、-0.330,P<0.05或P<0.01)。ROC曲线显示MLR、MPV判定肾小管损伤的曲线下面积分别为0.706、0.671。结论MLR、MPV的升高与T2DM患者肾小管损伤密切相关,具有一定临床参考价值。

Objective To explore the association between monocyte-to-lymphocyte ratio(MLR)or mean platelet volume(MPV)and renal tubular injury in type 2 diabetes mellitus(T2DM)patients.Methods A total of 278 T2DM patients were assigned to three groups according to their urinary albumin to urine creatinine ratio(UACR):normal-albuminuria group(Normal group,UACR<30mg/g),micro-albuminuria group(Micro group,30mg/g≤UACR<300mg/g),and macro-albuminuria group(Macro group,UACR≥300mg/g).They were divided into four subgroups(Q_(1)-Q_(4) group)according to MLR quartiles and four subgroups(Q_(1)′-Q_(4)′group)according to MPV quartiles.General clinical data were collected and blood routine,biochemical and urine tests were performed.MLR,estimated glomerular filtration rate(eGFR),and urinar α_(1)-microglobulin to creatinine ratio(α_(1)CR)were calculated,and α_(1)CR was regarded as an indicator for responding renal tubular injury.Associations between MLR、MPV and renal injury markers were performed by Spearman correlation coefficients.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of MLR and MPV on renal tubular injury.Results The levels of MLR and MPV in Normal group,Micro group and Macro group were increased successively,and the differences were statistically significant(all P<0.05).With the increase of MLR and MPV quartile,UACR and α_(1)CR were gradually increased,and the difference was statistically significant(all P<0.05).Spearman correlation analysis showed that MLR and MPV had positive correletions with UACR and α_(1)CR(r were 0.353,0.367;0.348,0.357;all P<0.01),and a negative correletion with eGFR(r were-0.337,-0.330;P<0.05 or P<0.01).ROC curve analysis showed that the AUC of MLR and MPV in predicting α_(1)CR>14.21mg/g was 0.706 and 0.671,respectively.Conclusion The elevation of MLR and MPV is closely related to renal tubule injury in T2DM patients,which has certain clinical reference value.