NLR、PLR对维持性血液透析患者预后的预测价值

The Prognostic Value of NLR and PLR in Patients with Maintenance Hemodialysis

目的:探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对维持性血液透析(MHD)患者预后的预测价值。方法:收集2017年1月至2020年10月在保山市人民医院行MHD治疗的119例患者的病历资料,根据患者PLR、NLR中位数进行分组,比较各组的临床资料,利用Kaplan-Meier生存曲线分析NLR组、PLR组的全因死亡率,利用COX回归模型分析患者全因死亡的危险因素,使用受试者操作特征曲线(ROC曲线)评估NLR对MHD患者全因死亡的预测价值。结果:PLR分组中,各项实验室检查指标、全因死亡率在2组间差异均无统计学意义(P>0.05);NLR分组中,白蛋白、超敏C反应蛋白(hsCRP)、单室尿素清除率、全因死亡率在2组间差异均有统计学意义(P<0.05);经过校正后的COX回归模型显示,年龄增加,NLR、hsCRP升高和单室尿素清除率降低可作为全因死亡率的独立预测因子;ROC曲线结果显示,NLR预测MHD患者全因死亡的曲线下面积为0.716(95%CI:0.598~0.833),敏感度为78.30%,特异度为64.60%。结论:NLR可独立预测MHD患者的预后。

Objective:To explore the prognostic value of neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)in patients with maintenance hemodialysis(MHD).Methods:Medical records of 119 patients who underwent MHD treatment at Baoshan People's Hospital from January 2017 to October 2020 were collected,and the patients were grouped according to the median PLR and NLR,and the clinical data of each group were evaluated.Kaplan-Meier survival curve was used to analyze all-cause mortality rates in the NLR and PLR groups.COX regression models were used to analyze the risk factors for all-cause mortality in the patients.The predictive value of NLR for all-cause mortality in MHD patients was evaluated using receiver operator characteristic(ROC)curve.Results:In the PLR group,there were no significant differences in laboratory parameters and all-cause mortality rates between the two groups(P>0.05).In the NLR group,there were significant differences in albumin,hypersensitive C-reactive protein(hsCRP),single-pool urea clearance rate,and all-cause mortality rates between the two groups(P<0.05).The adjusted COX regression model showed that the increasing age,elevated NLR,hsCRP and decreased single-pool urea clearance rate were independent predictors of all-cause mortality rate.The ROC curve analysis showed that the area under the curve for NLR in predicting all-cause mortality in MHD patients was 0.716(95%CI:0.598-0.833),with a sensitivity of 78.30%and specificity of 64.60%.Conclusion:NLR can independently predict the prognosis of MHD patients.