维持性血液透析患者单核细胞/高密度脂蛋白比值水平的影响因素分析

目的维持性血液透析(MHD)患者单核细胞与高密度脂蛋白比值(MHR)影响因素的调查和分析,为临床干预提供依据。方法2021年12月至2022年3月,选择本院血液净化中心MHD患者543例,将其分为高MHR组(≥0.53)293例和中低MHR(<0.53)250例,比较两组临床资料及实验室指标,包括性别、年龄、透析龄、血清白蛋白、前白蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、β2微球蛋白、高敏C反应蛋白、血清肌酐、血清钙、血清磷、血清尿素氮、尿素清除指数(Kt/V)等。并采用多因素Logistics回归对MHR的影响因素进行分析。结果两组性别、Kt/V、白蛋白、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、单核细胞数、淋巴细胞数、中性粒细胞数等比较,差异有统计学意义(P<0.05)。Logistics回归显示MHR与性别有关,Kt/V、血清白蛋白、总胆固醇、低密度脂蛋白胆固醇、淋巴细胞数、中性粒细胞数为独立影响因素(P<0.05)。结论透析不充分、营养不良、微炎症状态等是维持性血液透析患者MHR升高的危险因素,且增加MHD患者心血管事件风险。

Objective To investigate influencing factor of monocyte to high density lipoprotein ratio(MHR)in patients with maintenance hemodialysis(MHD),in order to provide evidence for clinical intervention.Methods A total of 543 MHD patients from the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine from December 2021 to March 2022 were selected.They were divided into the high MHR group(≥0.53)293 cases and the low MHR group(<0.53)250 cases.Clinical data and laboratory indexes of the two groups were compared,including sex,age,dialysis age,serum albumin,prealbumin,total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,β2-microglobulin,high-sensitive C-reactive protein,serum creatinine,serum calcium,serum phosphorus,blood urea nitrogen,urea clearance index(Kt/V),etc.Multi-factor Logistics regression analysis was used to analyze the influencing factors of MHR.Results Gender,Kt/V,albumin,cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,high-sensitive C-reactive protein,monocyte number,lymphocyte number and neutrophil number were compared between the two groups,and there were statistically significant differences(P<0.05).Logistics regression analysis showed that MHR was related to gender.Kt/V,serum albumin,total cholesterol,low density lipoprotein cholesterol,lymphocyte number and neutrophil number were independent influencing factors(P<0.05).Conclusion Inadequate dialysis,malnutrition and microinflammation can increase the MHR and risk of cardiovascular events in MHD patients.