外周血嗜酸性粒细胞升高对评估糖尿病肾病预后的临床价值

Prognostic value of elevated peripheral blood eosinophils for diabetic nephropathy

目的 评价外周血嗜酸性粒细胞计数(peripheral eosinophil count, PEC)在糖尿病肾病(diabetic nephropathy, DN)预后中的临床价值。方法 收集2021年3月至2023年3月在我院肾内科经肾活检确诊的220例DN患者的血常规、肾功能相关指标等临床资料进行回顾性队列研究。根据X-tile 3.6.1生物信息软件计算PEC的最佳截点值;采用Cox比例风险回归模型及Kaplan-Meier生存分析肾脏预后。结果 PEC水平与血肌酐(serum creatinine, Scr)(r=0.245)、血尿素氮(blood urea nitrogen, BUN)(r=0.237)和血尿酸(blood uric acid, UA)(r=0.252)水平呈正相关,与估算肾小球滤过率(estimated glomerular filtration rate, eGFR)(r=-0.236)呈负相关。根据PEC的最佳截点值(0.29×10^(9)/L)将DN患者分为高水平组(>0.29×10^(9)/L)(n=41)和低水平组(≤0.29×10^(9)/L)(n=179)。与低水平组比较,高水平PEC组患者的Scr(P<0.001)、BUN(P=0.001)和UA(P=0.005)水平明显高于低水平组患者,eGFR低于低水平组患者(P<0.001)。多因素Cox比例风险回归分析显示,高水平PEC与肾脏预后不良相关(HR=2.20,95%CI:1.05~4.60,P=0.036);Kaplan-Meier生存分析提示,高水平PEC组患者终末期肾病(end-stage renal disease, ESRD)发生率明显高于低水平组患者(P=0.024)。结论 PEC水平与DN的进展及预后密切相关,是预测DN预后的潜在生物标志物。

Objective To investigate the clinical value of peripheral eosinophil count(PEC)in predicting the outcome of diabetic nephropathy(DN).Methods A retrospective cohort trial was conducted on 220 DN patients identified by renal biopsy in Department of Nephrology of Second Affiliated Hospital from Army Medical University from March 2021 to March 2023.Clinical data,results of routine blood test and renal function were collected.X-tile bioinformatics software version 3.6.1 was used to determine the optimal cut-off value of PEC for predicting survival.Cox proportional hazards model and Kaplan-Meier survival analysis were applied to analyze the prognosis.Results The level of PEC in DN patients was positively correlated with the levels of serum creatinine(Scr)(r=0.245),blood urea nitrogen(BUN)(r=0.237)and blood uric acid(UA)(r=0.252),and negatively with estimated glomerular filtration rate(eGFR)(r=-0.236).According to the optimal PEC cut-off value,DN patients were divided into high-level group(>0.29×10^(9)/L,n=41)and low-level group(≤0.29×10^(9)/L,n=179).The levels of Scr(P<0.001),BUN(P=0.001)and UA(P=0.005)were significantly higher,while the eGFR(P<0.001)was obviously lower in the high-level group than the low-level group.Multivariate Cox regression analysis showed that the high level of PEC was associated with poor prognosis of DN(HR=2.20,95%CI:1.05~4.60,P=0.036).Kaplan-Meier survival analysis demonstrated that the incidence of end-stage renal disease(ESRD)was notably higher in the high-level group than the low-level group(P=0.024).Conclusion PEC level of DN patients is closely associated with the progression and prognosis of DN,and the count is a potential biomarker for predicting the prognosis of DN.