IgA肾病患者中性粒细胞-淋巴细胞比值与肾小管萎缩/间质纤维化相关性分析

Correlation between neutrophil-lymphocyte ratio and renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy

目的探讨IgA肾病(IgAN)患者中性粒细胞-淋巴细胞比值(NLR)与肾小管萎缩/间质纤维化的相关性,从而明确NLR能否作为评估IgAN疾病严重程度的参考指标。方法纳入2018年1月至2023年2月在安庆市立医院肾内科经肾活检确诊的161例原发性IgAN患者;根据NLR中位数将患者分为2组,比较2组之间临床指标及病理特征差异性;采用Spearman秩相关性分析法分析NLR与肾小管萎缩/间质纤维化的相关性;采用一元和多元线性回归模型分析肾小管萎缩/间质纤维化的相关因素;采用ROC曲线评估NLR预测IgAN患者中重度肾小管萎缩/间质纤维化的最佳截断值、敏感性和特异性。结果高NLR组收缩压、舒张压、白细胞计数、中性粒细胞计数、血尿素氮、血肌酐、24 h尿蛋白定量均高于低NLR组,淋巴细胞计数、血红蛋白、估算的肾小球滤过率(eGFR)均低于低NLR组(P<0.05);高NLR组肾小球硬化率、肾小管萎缩/间质纤维化率、T1+T2比例均高于低NLR组(P<0.05);Spearman秩相关分析结果显示,IgAN患者NLR水平和肾小管萎缩/间质纤维化率呈正相关(r=0.440,P<0.001);经过多元线性回归模型控制相关混杂因素后发现NLR与肾小管萎缩/间质纤维化程度呈独立显著正相关(β=0.155,t=2.539,P=0.012);ROC曲线分析结果显示NLR水平预测患者发生中重度肾小管萎缩/间质纤维化的最佳截断值为1.946,曲线下面积为0.719,敏感度和特异度分别为84.80%和57.00%。结论NLR与IgAN患者肾小管萎缩/间质纤维化程度密切相关,可作为评估IgAN疾病严重程度的参考指标。

Objective To explore the relationship between the neutrophil-lymphocyte ratio(NLR)and renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy(IgAN)and investigate whether NLR can be used as an indicator to assess the severity of IgAN.Methods A total of 161 patients with primary IgAN confirmed by renal biopsy who were admitted to the Department of Nephrology of Anqing Municipal Hospital from January 2018 to February 2023 were included in the study.The patients were divided into two groups according to the median NLR.The clinical indicators and pathological features were compared between the two groups,and the correlation between the NLR and renal tubular atrophy/interstitial fibrosis was assessed by Spearman rank correlation analysis.Univariate and multivariate linear regression analysis were used to analyze the factors associated with renal tubular atrophy/interstitial fibrosis.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the optimal cut-off value,sensitivity,and specificity of NLR for predicting moderate to severe renal tubular atrophy/interstitial fibrosis in patients with IgAN.Results The systolic blood pressure,diastolic blood pressure,white blood cell count,neutrophil count,urea nitrogen,creatinine,and 24-h urine protein level increased and the lymphocyte count,hemoglobin,and eGFR decreased with the increase of the NLR level(P<0.05).The percentages of patients glomerulosclerosis,renal tubular atrophy/interstitial fibrosis,and T1+T2 lesions were higher in patients with a higher level of NLR(P<0.05).The results of Spearman rank correlation analysis showed that there was a correlation between the levels of NLR and the percentage of patients with renal tubular atrophy/interstitial fibrosis in patients with IgAN(r=0.440,P<0.001).Multiple linear regression analysis showed that NLR was independently and positively associated with the degree of renal tubular atrophy/interstitial fibrosis in patients with IgAN(β=0.155,t=2.539,P=0.012).ROC curve analysis showed that the optimal cut-off value of NLR to predict moderate to severe renal tubular atrophy/interstitial fibrosis was 1.946 and the area under the curve was 0.719 with a sensitivity of 84.80%and specificity of 57.00%.Conclusion NLR is closely related to renal tubular atrophy/interstitial fibrosis in patients with IgAN and can be used as a marker to assess the severity of IgAN.