纤维蛋白原/白蛋白比值、全身炎症反应指数与慢性肾脏病患者肾功能进展的相关性研究

The relationship between the fibrinogen/albumin ratio and systemic inflammatory response index and the renal function progression in patients with chronic kidney disease

目的 探讨纤维蛋白原/白蛋白比值(FAR)、全身炎症反应指数(SIRI)与慢性肾脏病(CKD)3~5期患者肾功能进展的关系。方法 我院收治的CKD 3~5期患者437例,以FAR、SIRI中位数分别将患者分为高/低FAR组、高/低SIRI组,对所有患者进行随访,分析影响肾功能进展的危险因素,探讨FAR、SIRI与CKD患者肾功能进展的关系。结果 FAR和SIRI均与中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、白细胞(WBC)、纤维蛋白原(Fib)、高敏C反应蛋白(hs-CRP)呈正相关,与Alb呈负相关(P<0.05)。高FAR组与高SIRI组肾功能维持率低于低FAR组与低SIRI组(P<0.05)。高FAR水平、高SIRI水平、性别、糖尿病、P、eGFR是CKD 3~5期患者肾功能进展的独立危险因素(P<0.05)。FAR、SIRI、NLR、PLR、hs-CRP预测肾功能进展的ROC曲线下面积分别为0.763、0.700、0.662、0.624、0.627,灵敏度分别为80.5%、91.1%、44.7%、65.8%、36.8%,特异度为60.7%、39.4%、60.2%、55.1%、67.0%。FAR联合SIRI的曲线下面积、灵敏度、特异度分别为0.782、69.5%、74.9%。结论 高FAR、高SIRI均是CKD 3~5期患者肾功能进展的独立危险因素,且预测效能优于NLR、PLR、hs-CRP。

Objective To investigate the relationship between the fibrinogen/albumin ratio(FAR) and systemic inflammatory response index(SIRI) and the renal function progression in patients with stage 3~5 chronic kidney disease(CKD).Methods A total of 437 patients withstage 3~5 CKD admitted to our hospital were selected. Patients were divided into high/low FAR groups and high/low SIRI groups according to the median of FAR and SIRI, respectively. All patients were followed up. The risk factors affecting their renal function progression were analyzed, and the relationship between the FAR and SIRI and the renal function progression in patients with CKD was explored.Results FAR and SIRI were positively correlated with neutrophil/lymphocyte ratio(NLR), platelet/lymphocyte ratio(PLR), white blood cells(WBC), fibrinogen(Fib), and high-sensitivity C-reactive protein(hs-CRP) but negatively correlated with albumin(Alb)(P<0.05). The renal function maintenance rate in the high FAR and high SIRI groups was significantly lower than that in the low FAR and low SIRI groups. High FAR level, high SIRI level, gender, diabetes, phosphorus(P), and eGFR were independently correlated with renal function progression in patients with stage3~5 CKD(P<0.05). The areas under ROC curve of FAR, SIRI, NLR, PLR and hs-CRP for predicting renal function progression were 0.763, 0.700, 0.662, 0.624 and 0.627, respectively. The sensitivitywas 80.5%, 91.1%, 44.7%, 65.8% and 36.8%, respectively. The specificity was 60.7%, 39.4%, 60.2%, 55.1%, and 67.0%, respectively. The area under the curve, sensitivity and specificity of combined FAR and SIRI were 0.782,69.5% and 74.9%, respectively.Conclusions High FAR and high SIRI are independent risk factors for renal function progression in patients withstage 3~5 CKD, and their predictive efficacy may be superior to NLR, PLR and hs-CRP.