全血细胞衍生炎症标志物对移植肾功能延迟恢复的预警价值

Early warning value of whole blood cell derived inflammatory markers for delayed graft function of renal transplantation

目的 探讨术前全血细胞衍生炎症标志物[中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、全身免疫炎症指数(SII)和全身炎症反应指数(SIRI)]对移植肾功能延迟恢复(DGF)的预警价值。方法 选取2018年4月—2021年9月陆军军医大学第一附属医院接受同种异体肾移植术的患者191例,根据术后是否发生DGF,将患者分为DGF组(33例)和肾功能即刻恢复(IGF)组(158例)。收集所有患者的临床资料,并检测血常规,计算NLR、PLR、MLR、SII、SIRI。采用Logistic回归分析评估DGF发生的影响因素。采用受试者工作特征(ROC)曲线评价各项指标判断肾移植受者发生DGF的效能。结果 DGF组与IGF组之间冷缺血时间、热缺血时间、白细胞(WBC)计数、中性粒细胞绝对值(NEUT#)、淋巴细胞绝对值(LYMPH#)和出院时血清肌酐(SCr)差异均有统计学意义(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。DGF组术前NLR、PLR、MLR、SII、SIRI均显著高于IGF组(P<0.01)。ROC曲线分析结果显示,术前NLR、PLR、MLR、SII、SIRI单项检测和联合检测判断肾移植患者发生DGF的曲线下面积(AUC)分别为0.736、0.696、0.672、0.744、0.696、0.801。多因素Logistic回归分析结果显示,热缺血时间和术前PLR、SII是肾移植患者发生DGF的独立危险因素[比值比(OR)值分别为1.672、1.035、0.994,95%CI分别为1.104~2.533、1.008~1.063、0.989~1.000,P<0.05]。结论 术前全血细胞衍生炎症标志物在判断肾移植患者是否发生DGF中有潜在的临床应用价值。

Objective To investigate the early warning value of whole blood cell derived inflammatory markers[neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),monocyte/lymphocyte ratio(MLR),systemic immune inflammation index(SII)and systemic inflammation response index(SIRI)]for delayed graft function(DGF).Methods A total of 191 patients who received allograft renal transplantation in the First Affiliated Hospital of Army Medical University from April 2018 to September 2021 were enrolled.According to whether DGF occurred after operation,the patients were classified into DGF group(33 cases)and immediate graft function(IGF)group(158 cases).The clinical data of all the patients were collected,blood routine test was performed,and NLR,PLR,MLR,SII and SIRI were calculated.Logistic regression analysis was used to evaluate the influence factors of DGF.Receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of each indicator in determining DGF in renal transplantation patients.Results There was statistical significance on cold ischemia time,hot ischemia time,white blood cell(WBC)count,the absolute value of neutrophils(NEUT#),the absolute value of lymphocytes(LYMPH#)and serum creatinine(SCr)at discharge between DGF group and IGF group(P<0.05).There was no statistical significance for the other indicators between DGF group and IGF group(P>0.05).Preoperative NLR,PLR,MLR,SII and SIRI in DGF group were higher than those in IGF group(P<0.01).The areas under curves(AUC)of preoperative NLR,PLR,MLR,SII and SIRI single and combined determinations to determine DGF in renal transplantation patients were 0.736,0.696,0.672,0.744,0.696 and 0.801,respectively.Multivariate Logistic regression analysis showed that hot ischemia time and preoperative PLR and SII were independent risk factors for DGF in renal transplantation patients[odds ratios(OR)were 1.672,1.035 and 0.994,95%confidence intervals(CI)were 1.104-2.533,1.008-1.063,0.989-1.000,respectively,P<0.05].Conclusions Preoperative whole blood cell derived inflammatory markers have potential clinical value in determining whether DGF occurs in renal transplantation patients.