外周血NLR、PLR、NHR、MHR与老年终末期肾脏病患者微炎症状态的研究

Relationship Between NLR、PLR、NHR、MHR in Peripheral Blood and Microinflammatory State in Patients with End-stage Renal Disease

目的 探讨外周血中性粒细胞/淋巴细胞比率(NLR)、血小板/淋巴细胞(PLR)、中性粒细胞/高密度脂蛋白(NHR)、单核细胞/高密度脂蛋白(MHR)与老年终末期肾脏病(ESRD)患者体内微炎症状态的相关性。方法 选取2019年1月至2020年8月在我院血液净化中心行维持性血液透析的120例老年ESRD患者(GFR<15 ml/min/1.73 m~2)为观察组,按治疗方法不同分为透析组和非透析组各60例。根据hs-CRP水平,将老年ESRD患者分为hs-CRP低水平组80例(≤3.0 mg/L)和hs-CRP高水平组40例(>3.0 mg/L),hs-CRP>3.0 mg/L提示并发心血管疾病风险增高。另选取同时期我院健康体检者40名作为对照组。收集研究者的一般资料,并检查血常规、血生化指标及hs-CRP,计算NLR、PLR、LMR、NHR、MHR值。结果 老年ESRD患者中NEU、RDW、PDW、NLR、NHR、MHR、SCR、hs-CRP明显高于对照组,LYM、HGB、LMR、ALB明显低于对照组,差异有统计学意义(P<0.05)。透析组HGB、PDW、LMR、ALB、SCR显著高于非透析组,透析组MON、LMR、TCHO、HDL显著低于非透析组,差异有统计学意义(P<0.05)。spearman相关分析结果提示,NLR、PLR、NHR、MHR与hs-CRP呈正相关(P<0.05)。hs-CRP高水平组的ESRD患者的年龄、NEU、NLR、PLR、NHR、MHR显著高于hs-CRP低水平组,HGB、RBC、LYM、HDL、LMR显著低于hs-CRP低水平组,差异有统计学意义(P<0.05)。多元线性回归模型显示:高龄、高NHR是老年ESRD患者心血管疾病危险因素,HGB是老年ESRD患者心血管疾病保护因素(P<0.05)。ROC曲线分析年龄、NHR评估心血管疾病风险性,年龄、NHR及两者联合ROC下面积分别为0.822、0.795和0.881。结论 外周血NLR、PLR、NHR、MHR能反应ESRD老年患者体内微炎症状态,年龄、NHR可以评估老年ESRD患者心血管疾病风险性,两者联合预测老年ESRD患者心血管疾病风险性效能更优。

Objectives To investigate the correlation between neutrophil to lymphocyte ratio(NLR),Platelet to lymphocyte ratio(PLR),neutrophil to high density lipoprotein ratio(NHR),monocyte to high-density lipoprotein ratio(MHR)and microinflammatory status in elderly patients with end-stage renal disease(ESRD).Methods A total of 120 elderly ESRD patients(GFR<15 ml/min/1.73 m2)who underwent maintenance hemodialysis in the Blood Purification Center of the Affiliated Hospital of North Sichuan Medical College from January 2019 to August 2020 were selected as the study subjects.According to the treatment methods,the samples were divided into dialysis group and non-dialysis group,with 60 cases in each group.According to hs-CRP level,the elderly patients with ESRD patients were divided into hs-CRP low level group(<3.0mg/L,80 cases)and hs-CRP high level group(3.0>mg/L,40 cases).hs-CRP>3.0mg/L suggest an increased risk of cardiovascular disease.Another 40 healthy patients were selected as the control group.The general data of the researchers were collected,and the blood routine,biochemical indexes and hs-CRP were examined.The values of NLR,PLR,NHR and MHR were calculated.Results In elderly ESRD patients,NEU,RDW,PDW,NLR,NHR,MHR,SCR,hs-CRP were significantly higher than those in the control group,while LYM,HGB,LMR,ALB were significantly lower than those in the control group(P<0.05).The HGB,PDW,LMR,ALB,and SCR in the dialysis group were significantly higher than those in the non-dialysis group,while the MON,LMR,TCHO,and HDL in the dialysis group were significantly lower than those in the non-dialysis group(P<0.05).The Spearman correlation analysis results suggest that NLR,PLR,NHR,MHR were positively correlated with hs-CRP(P<0.05).The age,NEU,NLR,PLR,NHR,and MHR of ESRD patients in the high hs-CRP group were significantly higher than those in the low hs-CRP group,while HGB,RBC,LYM,HDL,and LMR were significantly lower than those in the low-hs CRP group(P<0.05).Multiple linear regression model showed that the advanced and high NHR were risk factors for cardiovascular disease in elderly ESRD patients,and HGB was a protective factor for cardiovascular disease in elderly ESRD patients(P<0.05).The risk of cardiovascular disease was assessed by receiver operating characteristic analysis of age and NHR.The area under ROC of age,NHR and their combined ROC were 0.822,0.795 and 0.881,respectively.Conclusions NLR,PLR,NHR and MHR in peripheral blood can reflect the micro inflammatory state in elderly patients with ESRD.Age and NHR can evaluate the risk of cardiovascular disease in elderly ESRD patients,and the combination of the two is more effective in prediction.