单核细胞/淋巴细胞比值与维持性血液透析患者全因死亡的相关性分析

Association between monocyte to lymphocyte ratio and all-cause death in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者单核细胞/淋巴细胞比值(monocyte/lymphocyte ratio,MLR)与全因死亡的相关性。方法单中心、回顾性、队列研究。收集2020年1月~2022年1月在南阳市中心医院血液净化科行MHD治疗的终末期肾病患者的基线临床资料和实验室检查指标。所有患者随防至2022年8月。分析MLR与MHD患者全因死亡事件的相关性。结果共259例患者纳入研究,男性55.2%,平均年龄(57.0±13.9)岁。中位随访时间22.0(11.0,27.0)月,至随访终点62例(23.9%)患者发生全因死亡。单因素COX回归分析结果显示MLR(HR=6.251,95%CI:2.654~14.723,P<0.001)、中性粒细胞/淋巴细胞比值(HR=1.119,95%CI:1.057~1.184,P<0.001)、全身免疫炎症指数(HR=1.001,95%CI:1.000~1.001,P<0.001)是MHD患者全因死亡的危险因素,多元COX回归分析结果显示:校正混杂因素后,MLR与全因死亡风险独立相关(HR=4.81,95%CI:1.32~17.53,P=0.017)。亚组分析显示在不同人群中,MLR作为MHD患者全因死亡的危险因素是稳定的。Kaplan-Meier生存曲线显示随着MLR的升高,生存率逐渐下降(Log-rank检验χ^(2)=12.248,P=0.007)。结论MLR水平升高是MHD患者全因死亡的独立危险因素,其与MHD患者生存率紧密相关。

Objectives To investigate the relationship between monocyte-lymphocyte ratio(MLR)and all-cause mortality in patients with maintenance hemodialysis(MHD).Methods This was a single-centered,retrospective and cohort study.Baseline clinical data and laboratory parameters were collected from the patients with end-stage renal disease(ESRD)and treated with MHD at the Department of Blood Purification,Nanyang Central Hospital from January 2020 to January 2022.All patients were followed up until August 2022.The relationship between MLR and all-cause mortality was analyzed in the MHD patients.Results A total of 259 patients were enrolled in the study,including 55.2%males and with an average age of 57.0±13.9 years old.The median follow-up time was 22.0(11.0,27.0)months,and all-cause death occurred in 62(23.9%)patients until the end of follow-up.Univariate Cox regression analysis showed that MLR(HR=6.251,95%CI:2.654~14.723,P<0.001),neutrophil/lymphocyte ratio(HR=1.119,95%CI:1.057~1.184,P<0.001),and systemic immune inflammatory index(HR=1.001,95%CI:1.000~1.001,P<0.001)were the risk factors for all-cause mortality in the MHD patients.Multivariate Cox regression analysis showed that MLR was independently correlated with the risk of all-cause mortality after adjusting the confounding factors(HR=4.81,95%CI:1.32~17.53,P=0.017).Subgroup analysis showed that MLR as a risk factor for all-cause mortality in MHD patients was stable in different populations.Kaplan-Meier survival curve showed a gradual decrease of survival along with the increase of MLR(Log-rank testχ^(2)=12.248,P=0.007).Conclusion The increase of MLR is an independent risk factor for all-cause mortality in MHD patients,and is closely related to the survival rate of MHD patients.