维持性血液透析患者肾性贫血与中性粒细胞/淋巴细胞比值的相关性

Correlation between renal anemia and neutrophil/lymphocyte ratio in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者肾性贫血与中性粒细胞/淋巴细胞比值(NLR)的关系并分析其发生的危险因素。方法选取2020年1月~2021年1月在西南医科大学附属医院血液透析室行MHD的患者140例,按照血红蛋白(Hb)水平将Hb<110 g/L设为贫血组(n=71),Hb≥110 g/L设为非贫血组(n=69)。收集患者一般资料及血红蛋白(Hb)、中性粒细胞绝对值(NEU)、淋巴细胞绝对值(LYM)、铁蛋白(FER)、叶酸(FA)、维生素B12(VitB12)、白蛋白(Alb)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、β2微球蛋白(β2-MG)等实验室指标。采用Pearson/Spearman法分析贫血与血中性粒细胞/淋巴细胞比值及上述指标的相关性,Logistic回归法分析肾性贫血发生的危险因素,并采用ROC曲线分析中性粒细胞/淋巴细胞比值对肾性贫血发生的预测价值。结果贫血组患者中性粒细胞/淋巴细胞比值及中性粒细胞绝对值水平显著高于非贫血组(P<0.05),而LYM、Alb、25-羟维生素D3[25-(OH)-VitD3]水平低于非贫血组,差异均有统计学意义(P<0.05),两组间年龄、透析龄、性别、并发症(高血压、糖尿病)、每周促红素用量、BMI、铁蛋白(FER)、FA、VitB12、CRP、SAA、β2-MG、Ca^(2+)、磷(P)、全段甲状旁腺激素(iPTH)等指标差异无统计学意义(P>0.05);相关性分析显示Hb水平与NLR(r=0.434)、CRP(r=0.178)呈负相关,与Alb(r=0.183)、25-(OH)-VitD3(r=0.243)、LYM(r=0.305)呈正相关(P均<0.05);Logistic回归分析显示,低血25-(OH)-VitD3水平、高NLR水平是MHD患者发生贫血的独立危险因素。ROC曲线分析结果显示,NLR预测MHD患者贫血发生的曲线下面积(AUC)为0.802,最佳诊断截值为3.563,敏感度为0.831,特异度为0.638。结论MHD患者中性粒细胞/淋巴细胞比值水平升高与血红蛋白水平降低密切相关,低血25-(OH)-VitD3及高NLR水平是MHD患者发生肾性贫血的独立危险因素。NLR有望成为辅助诊断MHD患者贫血的一项新指标。

Objective To investigate the risk factors of renal anemia in maintenance hemodialysis(MHD)patients and the association of neutrophil/lymphocyte ratio(NLR)level with renal anemia.Methods 140 patients who underwent MHD in the blood purification center of The Affiliated Hospital of Southwest Medical University from January 2020 to January 2021 were selected and divided into anemia group and non anemia group according to the level of hemoglobin(HB).The general data,hemoglobin(HB),neutrophil absolute value(NEU),lymphocyte absolute value(LYM),ferritin(FER),folic acid(FA),vitamin B12(VitB12),albumin(ALB),C-reactive protein(CRP),serum amyloid A(SAA),β2 microglobulin(β2-MG)and other laboratory indexes were collected.Pearson/Spearman method was used to analyze the correlation between anemia and blood neutrophil/lymphocyte ratio and the above indexes.Logistic regression method was used to analyze the risk factors of renal anemia,and ROC curve was used to analyze the predictive value of neutrophil/lymphocyte ratio for anemia.Results 140 patients with MHD were included,including 71 cases(50.7%)in anemia group and 69 cases(49.3%)in non anemia group.The levels of neutrophil/lymphocyte ratio and neutrophil absolute value in anemia group were significantly higher than that in non anemia group(P<0.05),while the levels of LYM、ALB and 25-(OH)-VitD3 were lower than that in non anemia group(P<0.05).There was no difference in age,dialysis age,gender,complications(hypertension,diabetes),Weekly erythropoietin dosage,BMI,FER,FA,VitB12,CRP,SAA,β2-MG,Ca^(2+),P and iPTH between the two groups(P>0.05).Correlation analysis showed that Hb level was negatively correlated with NLR(r=0.434)and CRP(r=0.178),and positively correlated with ALB(r=0.183)、25-(OH)-VitD3(r=0.243)and LYM(r=0.305)(all P<0.05).Logistic regression analysis showed that low blood 25-(OH)-VitD3 level and high NLR level were independent risk factors for anemia in MHD patients.ROC curve analysis showed that the area under the curve(AUC)of NLR for predicting anemia in MHD patients was 0.802,the best diagnostic cut-off value was 3.563.The sensitivity was 0.831 and the specificity was 0.638.Conclusion The increase of neutrophil/lymphocyte ratio in MHD patients is closely related to the decrease of hemoglobin level.Low blood 25-(OH)-VitD3 level and high NLR level are independent risk factors for renal anemia in MHD patients.NLR is expected to become a new index to assist in the diagnosis of anemia in MHD patients.