中性粒细胞/淋巴细胞比值对肾功能正常的老年高血压患者尿白蛋白/尿肌酐比值升高的预测价值

Predictive value of the ratio of neutrophil to lymphocyte for the elevation of the ratio of urinary albumin tourinary creatinine in elderlyhypertension patients with normal renal function

目的 探讨中性粒细胞/淋巴细胞比值(NLR)对肾功能正常的老年高血压患者尿白蛋白/尿肌酐比值(UACR)升高的预测价值。方法 根据UACR水平将403例肾功能正常的老年高血压患者分为UACR升高组(UACR≥30 mg/g, 123例)和UACR正常组(UACR<30 mg/g, 280例);其中,UACR升高组又分为轻度升高组(30 mg/g≤UACR<300 mg/g, 93例)和重度升高组(UACR≥300 mg/g, 30例)。回顾性分析患者的临床资料。采用多因素logistic回归分析UACR升高及重度升高的危险因素,ROC曲线评估NLR对UACR升高的预测价值。结果 与UACR正常组比较,UACR升高组年龄大,女性、吸烟、2型糖尿病比例高,SBP、NLR、尿酸和LDL-C水平高(P<0.05)。重度升高组2型糖尿病比例以及SBP、NLR、TC、LDL-C水平高于轻度升高组(P<0.05)。高NLR、高SBP、2型糖尿病、高龄、高尿酸和高LDL-C是UACR升高的独立危险因素(P<0.05)。高NLR、高SBP和高TC是UACR重度升高的独立危险因素(P<0.05)。NLR预测UACR升高的ROC曲线下面积为0.833[95%CI(0.793~0.874)],取最佳诊断界值为2.191时,其预测UACR升高的灵敏度为81.3%,特异度为72.1%。结论 对于肾功能正常的老年高血压患者,高NLR是UACR升高及重度升高的危险因素,NLR对UACR升高有较好的预测价值。

Objective To explore the predictive value of the ratio of neutrophil to lymphocyte(NLR) for the elevation of the ratio of urinary albumin to urinary creatinine(UACR) in elderly hypertension patients with normal renal function.Methods A total of 403 elderly hypertension patients with normal renal function were divided into group A(UACR≥30 mg/g, 123 cases) and group B(UACR<30 mg/g, 280 cases).The patients in group A were subdivided into group A1(30≤UACR<300 mg/g, 93 cases) and group A2(UACR≥300 mg/g, 30 cases). The clinical data of the patients were retrospectively analyzed. The risk factors for UACR elevation and severe elevation were analyzed by multivariate logistic regression analysis. The value of NLR in predicting UACR elevation was evaluated by ROC curve analysis.Results Compared with group B, group A had older age, higher proportions of female, smoking and type 2 diabetes(T2DM) and the levels of SBP, NLR, uric acid and LDL-C(P<0.05). The proportion of the patients with T2DM and the levels of SBP, NLR, TC and LDL-C in group A2 were higher than those in group A1(P<0.05).Higher NLR, higher SBP, T2DM, advanced age, higher levels of uric acid and LDL-C were the independent risk factors for UACR elevation(P<0.05). Higher NLR, higher SBP and higher TC were the independent risk factors for severe UACR elevation(P<0.05). The area under the ROC curve of NLR in predicting UACR elevation was 0.833 [95%CI(0.793-0.874)].Taking 2.191 as the optimal cut-off value, the sensitivity and specificity of NLR predicting UACR elevation were 81.3% and 72.1%,respectively.Conclusion For elderly hypertension patients with normal renal function, higher NLR is a risk factor for UACR elevation and severe UACR elevation, and NLR has better predictive value for UACR elevation.