新型炎症指数在糖尿病肾病患者全因死亡中的预测价值

Predictive value of new inflammatory index in all-cause mortality in patients with diabetic kidney disease

目的探究基于多种外周血液指标构建的新型炎症指数对糖尿病肾病(DKD)患者全因死亡的预测作用。方法分析美国国家健康与营养调查数据库1999—2018年10个周期的DKD人群的临床数据。通过单因素、多因素Cox回归分析探究4种新型炎症指数,即系统免疫炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)与DKD患者全因死亡的相关性。各指标预测DKD患者全因死亡率的准确性通过时间依赖性受试者工作特征曲线下面积(AUC)进行评估。结果共纳入2043例参与者,中位年龄70岁。SII、NLR、PLR、MLR均与DKD患者全因死亡明显相关(Q 4的风险比=1.61、1.61、1.28、1.62,95%可信区间1.35~1.95、1.32~1.97、1.07~1.53、1.32~2.00,P<0.001、P<0.001、P=0.007、P<0.001)。SII、NLR、MLR、PLR的AUC分别为67.68%、59.10%、58.31%、61.89%。结论4种新型炎症指数与DKD患者全因死亡显著相关。新型炎症指数具有为DKD患者随访提供预后评估价值。

Objective To explore the predictive effect of a new inflammatory index based on multiple peripheral blood indicators on all-cause mortality in patients with diabetic kidney disease(DKD).Methods The clinical data of DKD population in 10 cycles from 1999 to 2018 in the National Health and Nutrition Examination Survey(NHANES)database were analyzed.Univariate and multivariate Cox regression analysis were uesd to explore the correlation between four new inflammatory indexes,including systemic immune inflammatory index(SII),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR)and all-cause mortality in DKD patients.The accuracy of each index in predicting all-cause mortality in DKD patients was evaluated by the area under time-dependent receiver operating characteristic curve(AUC).Results A total of 2043 participants were included,with a median age of 70 years.SII,NLR,PLR and MLR were significantly associated with all-cause mortality in DKD patients(RR at Q 4=1.61,1.61,1.28,1.62,95%CI 1.35-1.95,1.32-1.97,1.07-1.53,1.32-2.00,P<0.001,P<0.001,P=0.007,P<0.001).The AUC of SII,NLR,MLR and PLR were 67.68%,59.10%,58.31%and 61.89%,respectively.Conclusion Four new inflammatory indices are significantly associated with all-cause mortality in DKD patients.The new inflammatory index has predictive value for the follow-up of DKD patients.