肾虚血瘀型颈动脉粥样硬化与MHR、NLR、血清25-羟维生素D_(3)关系的临床分析

Clinical analysis of the relationship among MHR,NLR,serum 25-(OH)D_(3) and carotid atherosclerosis of kidney deficiency and blood stasis type

目的:探讨肾虚血瘀型颈动脉粥样硬化(CAS)患者血清25-羟维生素D_(3)[25-(OH)D_(3)]、单核细胞/高密度脂蛋白胆固醇比值(MHR)、中性粒细胞/淋巴细胞比值(NLR)的水平,并分析其与肾虚血瘀型CAS的关系。方法:选择2020年12月至2022年12月我院收治的CAS患者247例,根据辨证标准分为非肾虚组(70例),肾精亏虚组(97例),肾虚血瘀组(80例),比较三组研究对象临床资料、血清25-(OH)D_(3)、MHR、NLR,分析肾虚血瘀型CAS的影响因素。结果:与非肾虚组比较,肾精亏虚组、肾虚血瘀组MHR[(0.41±0.27)比(0.49±0.20)比(0.55±0.20)]显著升高(P<0.05或<0.01);与非肾虚组及肾精亏虚组比较,肾虚血瘀组NLR[(2.55±1.53)比(3.14±2.29)比(4.03±2.70)]显著升高(P均<0.01);与非肾虚组及肾精亏虚组比较,肾虚血瘀组血清25-(OH)D_(3)[(24.08±2.87)ng/ml比(17.77±1.94)ng/ml比(16.24±2.19)ng/ml]显著降低(P均=0.001)。Logistic回归分析显示,血清25-(OH)D_(3)是肾虚血瘀型CAS的独立保护因素(OR=0.619,P=0.001),MHR是其独立危险因素(OR=6.064,P=0.015)。结论:血清25-(OH)D_(3)、MHR、NLR水平与肾虚血瘀型CAS密切联系,血清25-(OH)D_(3)、MHR可作为评估肾虚血瘀型CAS的辅助检测指标。

Objective:To investigate serum levels of 25-(OH)D_(3),monocyte-to-high density lipoprotein cholesterol ratio(MHR)and neutrophil-to-lymphocyte ratio(NLR)in carotid atherosclerosis(CAS)patients with kidney deficiency and blood stasis(KDBS)type,and analyze their relationship with KDBS type CAS.Methods:A total of 247 CAS patients who were treated in our hospltal from Dec 2020 to Dec 2022 were selected and divided into non-kidney deficiency(NKD)group(n=70),kidney-jing deficiency(KJD)group(n=97)and KDBS group(n=80)according to dialectical criteria.The clinical data,serum 25-(OH)D_(3),MHR,NLR were compared among three groups.Influencing factors for KDBS type CAS were analyzed.Results:Compared with NKD group,there were significant rise in MHR[(0.41±0.27)vs.(0.49±0.20)vs.(0.55±0.20)]in KJD group and KDBS group(P<0.05 or<0.01).Compared with NKD group and KJD group,there was significant rise in NLR[(2.55±1.53)vs.(3.14±2.29)vs.(4.03±2.70)]in KDBS group(P<0.01 all).Compared with NKD group and KJD group,there was significant reduction in serum 25-(OH)D_(3) level[(24.08±2.87)ng/ml vs.(17.77±1.94)ng/ml vs.(16.24±2.19)ng/ml]in KDBS group(P=0.001 all).Logistic regression analysis showed that serum 25-(OH)D_(3) was an independent protective factor for KDBS type CAS(OR=0.619,P=0.001),while MHR was its independent risk factor(OR=6.064,P=0.015).Conclusion:Serum 25-(OH)D_(3),MHR and NLR are closely associated with kidney deficiency and blood stasis type carotid atherosclerosis,serum 25-(OH)D_(3) and MHR can be used as auxiliary detection indexes for evaluating carotid atherosclerosis of kidney deficiency and blood stasis type.