中性粒细胞与淋巴细胞比值对老年腹膜透析患者预后的影响

Effect of baseline neutrophil to lymphocyte ratio on the prognosis of elderly peritoneal dialysis patients

目的探讨中性粒细胞与淋巴细胞比值(NLR)对老年腹膜透析患者心血管死亡预后的影响。方法本研究为单中心回顾性研究,选取2015年1月至2021年9月北部战区总医院肾脏病科收治的136例行腹膜透析置管术并规律随访的老年患者,男58例,女78例,年龄(72.30±5.54)岁,年龄范围为65~86岁。采用受试者操作特征(ROC)曲线预测患者心血管死亡风险,采用Kaplan-Meier法计算患者生存率,采用多因素Cox回归比例风险模型分析影响预后的危险因素。结果淋巴细胞、中性粒细胞、NLR预测患者心血管死亡风险的ROC曲线下面积(0.592)优于淋巴细胞(0.326)及中性粒细胞(0.468),NLR的最佳截断值为8.30,根据NLR的不同将患者分为低NLR组(NLR<8.30,n=106)与高NLR组(NLR≥8.30,n=30)。高NLR组患者的体质量指数[(21.73±3.49)kg/m2]低于低NLR组[(23.96±3.34)kg/m2]、白蛋白水平[31.20(27.03,36.98)g/L]低于低NLR组[34.90(30.90,38.00)g/L]、中性粒细胞水平[8.30(5.63,11.15)×109/L]高于低NLR组[4.47(3.48,5.73)×109/L]、淋巴细胞水平[0.60(0.33,0.70)g/L]低于低NLR组[1.00(0.80,1.31)g/L],差异均有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析显示,高NLR组的患者的生存率(38.4%)低于低NLR组(47.4%),差异有统计学意义(P<0.05)。多因素Cox回归分析结果显示,NLR是腹膜透析患者心血管死亡的独立危险因素,体质量指数是其保护因素(P<0.05)。结论NLR是老年腹膜透析患者心血管死亡的独立危险因素,对老年腹膜透析患者的预后具有预测价值。

Objective To explore the effect of neutrophil lymphocyte ratio(NLR)on the prognosis of elderly patients with peritoneal dialysis(PD).Methods This study was a single center retrospective study,a total of 136 elderly patients who underwent PD catheterization in the Nephrology department of Northern Theater General Hospital were followed up regularly from January 2015 to September 2021,there were 58 males and 78 females,aged(72.30±5.54)years old,ranging from 65 to 86 years old.Receiver operator characteristic(ROC)curve was used to predict cardiovascular mortality risk,Kaplan-Meier method was used to calculate the survival rate,multivariate Cox regression proportional hazard model was established to determine the independent prognostic factors.Results The area under the ROC of lymphocyte,neutrophil and NLR to predict the risk of cardiovascular death(0.592)was better than that of lymphocytes(0.326)and neutrophils(0.468),the optimal cut-off value of the NLR for predicting cardiovascular mortality was 8.30,the patients were divided into low NLR group(NLR<8.30,n=106)and high NLR group(NLR≥8.30,n=30).The body mass index of the high NLR group[(21.73±3.49)kg/m2]was lower than that of the low NLR group[(23.96±3.34)kg/m2],albumin levels[31.20(27.03,36.98)g/L]was lower than that in the low NLR group[34.90(30.90,38.00)g/L],neutrophil level[8.30(5.63,11.15)×109/L]was higher than that in the low NLR group[4.47(3.48,5.73)×109/L],lymphocyte level[0.60(0.33,0.70)g/L]was lower than that in the low NLR group[1.00(0.80,1.31)g/L],the differences were statistically significant(P<0.05).Kaplan-Meier survival curve analysis showed that the survival rate of patients in high NLR group(38.4%)was significantly lower than that in low NLR group(47.4%),the difference was statistically significant(P<0.05).Multivariate Cox regression analysis showed that NLR was an independent risk factor for cardiovascular death in peritoneal dialysis patients,and body mass index was a protective factor(P<0.05).Conclusions NLR is an independent risk factor for cardiovascular mortality in elderly PD patients and has predictive value for the prognosis of elderly PD patients.