中性粒细胞/淋巴细胞比值联合肾小管萎缩/间质纤维化对IgA肾病患者发生终点事件的预测价值

Predictive value of neutrophil/lymphocyte ratio combined with renal tubular atrophy/interstitial fibrosis in the endpoint of patients with IgA nephropathy

目的 探讨中性粒细胞/淋巴细胞比值(NLR)联合肾小管萎缩/间质纤维化(T,指病理分类)对IgA肾病(IgAN)患者发生终点事件的预测价值。方法 回顾性分析2015年1月1日至2018年8月1日于郑州大学第一附属医院肾脏内科就诊的原发性IgAN患者的临床资料。以发生终末期肾病、死亡、血肌酐较基线值翻倍等为终点事件。根据受试者工作特征(ROC)曲线确定的NLR预测IgAN发生终点事件的最佳截断值将患者分为低NLR组和高NLR组。收集患者的基线资料,分析影响IgAN患者发生终点事件的危险因素及不同指标对IgAN患者发生终点事件的预测效能。结果 ROC曲线分析结果显示NLR预测IgAN患者发生终点事件的最佳截断值为2.407,以此将患者分为低NLR组(247例,NLR≤2.407)和高NLR组(103例,NLR>2.407)。高NLR组高血压病比例、血尿素氮、血肌酐、血尿酸水平均高于低NLR组,血红蛋白水平低于低NLR组;病理分类方面,高NLR组内皮细胞增生、肾小球节段硬化或粘连、T病变范围26%~50%(T1)/>50%(T2)比例均高于低NLR组[43.7%(45/103)比24.3%(60/247)、76.7%(79/103)比59.5%(147/247)、45.6%(47/103)比19.0%(47/247)],差异均有统计学意义(均P<0.05)。高NLR组终点事件发生率高于低NLR组,无终点事件生存率低于低NLR组,差异均有统计学意义(均P<0.001)。多因素Cox回归模型分析结果显示,血肌酐、NLR、T1及T2是IgAN患者发生终点事件的独立危险因素(均P<0.05)。ROC曲线分析结果显示,NLR与血肌酐、NLR与T联合预测的曲线下面积均大于三者单独预测,其中NLR联合T的曲线下面积最大。结论 NLR联合T对IgAN患者的不良预后具有较高的预测效能,对于指导临床诊疗具有重要意义。

Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR) combined with renal tubular atrophy/interstitial fibrosis(T) in the endpoint of patients with IgA nephropathy(IgAN). Methods The clinical data of patients with primary IgAN were analyzed retrospectively in Department of Nephrology, the First Affiliated Hospital of Zhengzhou University from January 1, 2015 to August 1, 2018. The end stage renal disease, death, double serum creatinine and so on were used as endpoint. Receiver operating characteristic(ROC) curve was used to determine the best cut-off value of NLR to predict the endpoint in patients with IgAN, and the patients were divided into low-NLR group and high-NLR group according to that. The baseline data of patients were collected. The risk factors affecting the endpoint and the predictive efficacy of indicators on the endpoint in patients with IgAN were analyzed. Results ROC curve analysis showed that the best cut-off value of NLR predicting the endpoint in patients with IgAN was 2.407, and patients were divided into low-NLR group(247 cases, NLR≤2.407) and high-NLR group(103 cases, NLR>2.407). The rate of hypertension, levels of blood urea nitrogen, serum creatinine and blood uric acid in high-NLR group were higher than those in low-NLR group, and the level of hemoglobin was lower than that in low-NLR group;in terms of pathological classification, the rates of endothelial cell proliferation, glomerular segmental sclerosis or adhesion, and T with lesion extent as 26%-50%(T1)/>50%(T2) in high-NLR group were higher than those in low-NLR group [43.7%(45/103) vs 24.3%(60/247), 76.7%(79/103) vs 59.5%(147/247), 45.6%(47/103) vs 19.0%(47/247)](all P<0.05). The incidence of endpoint in high-NLR group was higher than that in low-NLR group, and non-endpoint survival rate was lower than that in low-NLR group(both P<0.001). Multivariate Cox regression analysis showed that serum creatinine, NLR, T1 and T2 were independent risk factors for the endpoint in patients with IgAN(all P<0.05). ROC curve analysis showed that the areas under the curve of NLR combined with serum creatinine and NLR combined with T were larger than those three alone in predicting the endpoint in patients with IgAN, and the area of NLR combined with T was the largest. Conclusion NLR combined with T can effectively predict the adverse prognosis in patients with IgAN, which is of great significance for guiding clinical diagnosis and treatment.