单核细胞与高密度脂蛋白胆固醇比值是慢性肾衰竭血液透析患者2年内死亡的独立影响因素

The ratio of monocyte to high-density lipoprotein cholesterol is an independent factor for 2-year death in hemodialysis patients with chronic renal failure

目的:探讨单核细胞与高密度脂蛋白胆固醇比值(MHR)对慢性肾衰竭血液透析患者预后的预测价值。方法:收集112例行维持性血液透析(MHD)治疗的慢性肾衰竭患者的临床资料,于MHD治疗当天开始进行随访,记录患者2年内生存情况。采用受试者工作特征(ROC)曲线评价MHR预测患者死亡的最佳截断值及其灵敏度和特异度,根据ROC曲线所得MHR最佳截断值,将研究对象分为高MHR组和低MHR组;采用多因素Cox回归法分析慢性肾衰竭血液透析患者2年内死亡的独立预测因素。结果:Cox回归分析显示年龄、合并糖尿病或脑卒中、白细胞计数、单核细胞计数、高密度脂蛋白胆固醇(HDL-C)、MHR是慢性肾衰竭血液透析患者2年内死亡的独立预测因素;ROC曲线结果显示MHR预测慢性肾衰竭血液透析患者2年内死亡的曲线下面积为0.821(95%CI:0.752~0.890),最佳截断值为0.37,其灵敏度为65.8%,特异度为93.1%。结论:MHR是慢性肾衰竭血液透析患者2年内死亡的独立预测因素,临床医师需注意患者血液透析前MHR水平。

Objective:To investigate the prognostic value of monocyte to high density lipoprotein cholesterol ratio(MHR)in hemodialysis patients with chronic renal failure.Methods:The clinical data of 112 patients with chronic renal failure treated by maintenance hemodialysis(MHD)were collected and the patients were followed up from the day of MHD treatment.The survival of the patients within 2 years was recorded.The receiver operating characteristic(ROC)curve was used to evaluate the optimal cut-off value and sensitivity and specificity of MHR in predicting patient death.According to the optimal cut-off value of MHR obtained by ROC curve,subjects were divided into high MHR group and low MHR group.Multivariate Cox regression was used to analyze the independent predictors of 2-year death in hemodialysis patients with chronic renal failure.Results:Cox regression analysis showed that age,diabetes mellitus or stroke,white blood cell count,monocyte count,high-density lipoprotein cholesterol(HDL-C),and MHR were independent predictors of 2-year death in hemodialysis patients with chronic renal failure.ROC curve results showed that MHR predicted death within 2 years in hemodialysis patients with chronic renal failure by 0.821(95%CI:0.752-0.890),the optimal cut-off value was 0.37,the sensitivity was 65.8%,and the specificity was 93.1%.Conclusions:MHR is an independent predictor of 2-year death in patients with chronic renal failure on hemodialysis.Clinicians should pay attention to the level of MHR before hemodialysis.