NLR、PLR对2型糖尿病肾病的预测价值

The predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in the type 2 diabetic nephropathy

目的探讨中性粒细胞/淋巴细胞(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞(platelet-to-lymphocyte ratio,PLR)与2型糖尿病肾病(type 2 diabetic nephropathy,T2DN)的相关性,并探讨NLR、PLR独立及联合检测预测T2DN的价值。方法回顾性分析2021年12月至2023年9月山西白求恩医院内分泌科收治的2型糖尿病患者300例,根据尿白蛋白/肌酐(albumin-creatinin ratio,ACR)结果将患者分为正常蛋白尿(A1)组100例、微量蛋白尿(A2)组100例、大量蛋白尿(A3)组100例。采集空腹血测定临床指标(血常规、血生化、糖化血红蛋白等),并测定ACR。结果A3组和A2组患者的NLR、PLR均高于A1组(P<0.05);A3组患者的NLR、PLR均高于A2组(P<0.05);Logistic回归分析显示,NLR(OR=1.702,95%CI:1.290~2.247,P<0.001)、PLR(OR=1.007,95%CI:1.001~1.014,P=0.033)是T2DN的独立危险因素;受试者操作特征曲线显示,NLR较PLR有更高的预测价值[曲线下面积(area under the curve,AUC):0.715 vs.0.655],截断值分别为1.975、126.135时,对应的敏感度、特异性分别为72.0%、64.0%和53.0%、74.0%。NLR联合PLR预测T2DN的AUC为0.714,敏感度68.0%、特异性68.5%。结论NLR和PLR均是T2DN的危险因素,均可用来预测T2DN,其中NLR的预测价值更大,NLR联合PLR检测的预测价值并未较NLR单独检测有所提升。

Objective To discuss the correlation of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)with type 2 diabetic nephropathy(T2DN),and to analyze the value of NLR and PLR independent and combined detection in predicting T2DN.Methods A total of 300 patients with type 2 diabetes mellitus from Department of Endocrinology,Shanxi Bethune Hospital from December 2021 to September 2023 were analyzed retrospectively.According to the urinary albumin-creatinin ratio(ACR),patients were divided into the normal albuminuria group(A1 group,n=100),microalbuminuria group(A2 group,n=100)and the macroalbuminuria group(A3 group,n=100).The clinical and biochemical data(blood routine,blood biochemistry,glycosylated hemoglobin A1c,etc)were collected by fasting blood.Results NLR and PLR of patients in A3 group and A2 group were higher than those in A1 group(P<0.05).NLR and PLR of patients in A3 group were higher than those in A2 group(P<0.05).Logistic regression analysis displayed that NLR(OR=1.702,95%CI:1.290-2.247,P<0.001]and PLR(OR=1.007,95%CI:1.001-1.014,P=0.033)were risk factors for T2DN.According to the analysis of receiver operating characteristic curve,the value of NLR for predicting T2DN was higher than PLR[area under the curve(AUC):0.715 vs.0.655].The cut-off values of NLR and PLR for predicting T2DN were 1.975 and 126.135,the corresponding sensitivity and specificity were 72.0%,64.0%and 53.0%,74.0%respectively.When NLR was combined with PLR,the AUC was 0.714,the sensitivity of combined prediction was 68.0%,and the specificity was 68.5%.Conclusion NLR and PLR are both risk factors for T2DN,and both can be used to predict T2DN.NLR has the greatest predict value for T2DN.The combined predictive value of NLR and PLR were not improved compared with NLR alone.