单核细胞/粒细胞与淋巴细胞比值与2型糖尿病患者发生白蛋白尿和肾功能不全的关系

Relationship of monocyte/granulocyte to lymphocyte ratio with albuminuria and renal dysfunction in patients with type 2diabetes mellitus

目的 探讨单核细胞/粒细胞与淋巴细胞比值(MGLR)与2型糖尿病(T2DM)患者发生白蛋白尿和肾功能不全的关系。方法 543例T2DM患者根据尿白蛋白/尿肌酐比值(UACR)将患者分为UACR正常组(UACR<3 mg/mmol, 244例)、微量白蛋白尿组(3 mg/mmol≤UACR<30 mg/mmol, 200例)和大量白蛋白尿组(UACR≥30 mg/mmol, 99例);另外根据估算肾小球滤过率(eGFR)又将患者分为eGFR正常组(eGFR≥90 mL·min^(-1)·1.73 m^(-2),438例)和eGFR受损组(eGFR<90 mL·min^(-1)·1.73 m^(-2),105例)。收集患者一般资料及实验室指标,计算MGLR,采用Spearman相关系数分析MGLR与T2DM患者发生白蛋白尿和eGFR受损的关系,logistic回归分析评估T2DM患者发生白蛋白尿和eGFR受损的危险因素,ROC曲线分析MGLR对T2DM患者发生白蛋白尿和eGFR受损的诊断价值。结果 与UACR正常组比较,微量白蛋白尿组和大量白蛋白尿组年龄较大,糖尿病病程较长,收缩压、SCr、UACR和MGLR较高,eGFR较低(P<0.05);与微量白蛋白尿组比较,大量白蛋白尿组年龄较大,糖尿病病程较长,收缩压、SCr、UACR和MGLR较高,eGFR较低(P<0.05)。与eGFR正常组比较,eGFR受损组年龄较大,糖尿病病程较长,收缩压、SCr、UACR和MGLR较高,而空腹血糖、HbA1c、TC、LDL-C、白蛋白和eGFR较低(P<0.05)。MGLR与UACR呈正相关(rs=0.530,P<0.01),与eGFR呈负相关(rs=-0.310,P<0.01)。MGLR较高是T2DM患者发生白蛋白尿和eGFR受损的独立危险因素(P<0.01)。当MGLR取最佳诊断界值为2.40时,其诊断T2DM患者发生白蛋白尿的灵敏度和特异度分别为53.2%和95.5%,诊断T2DM患者发生eGFR受损的灵敏度和特异度分别为61.0%和75.8%。结论 MGLR与T2DM患者发生白蛋白尿和肾功能不全密切相关,MGLR对其有一定的诊断价值。

Objective To investigate the relationship of monocyte/granulocyte to lymphocyte ratio(MGLR)with albuminuria and renal dysfunction in the patients with type 2diabetes mellitus(T2DM).Methods According to urinary albumin to creatinine ratio(UACR),543T2DM patients were divided into groups of A(UACR<3mg/mmol,244cases),B(3mg/mmol≤UACR<30mg/mmol,200cases)and C(UACR≥30mg/mmol,99cases).According to estimated glomerular filtration rate(eGFR),the patients were divided into groups of D(eGFR≥90mL·min^(-1)·1.73m^(-2),438cases)and E(eGFR<90mL·min^(-1)·1.73m^(-2),105cases).The general data and laboratory indicators were collected and MGLR was calculated.The relationship of MGLR with albuminuria and eGFR impairment of T2DM patients was analyzed by Spearman correlation analysis.The risk factors for albuminuria and eGFR impairment of T2DM patients were analyzed by logistic regression analysis.The diagnostic value of MGLR in albuminuria and eGFR impairment of T2DM patients was analyzed by ROC curve.Results Compared with group A,group B and group C had older age,longer diabetes course,higher systolic blood pressure,SCr,UACR and MGLR and lower eGFR(P<0.05).Compared with group B,the age was older,the course of diabetes was longer,systolic blood pressure,SCr,UACR and MGLR were higher,and eGFR was lower in group C(P<0.05).Compared with group D,group E had older age,longer course of diabetes,higher systolic blood pressure,SCr,UACR and MGLR,and lower fasting blood glucose,HbA1c,TC,LDL-C,albumin and eGFR(P<0.05).MGLR was positively correlated with UACR(rs=0.530,P<0.01),and negatively correlated with eGFR(rs=-0.310,P<0.01).Higher MGLR was an independent risk factor for albuminuria and impaired eGFR in T2DM patients(P<0.01).Taking MGLR 2.40as the optimal value,the sensitivity and specificity for diagnosing albuminuria in T2DM patients were 53.2%and 95.5%,respectively,and the sensitivity and specificity for diagnosing eGFR impairment in T2DM patients were 61.0%and 75.8%,respectively.Conclusion MGLR is closely associated with albuminuria and renal dysfunction in the patients with T2DM,which has certain diagnostic value.