基线正常中性粒细胞/淋巴细胞比值变化与糖尿病周围神经病变患病风险相关性的研究

Changes in baseline normal neutrophil/lymphocyte ratio and the risk of diabetic peripheral neuropathy

目的 探讨基线正常中性粒细胞/淋巴细胞比值(NLR)水平与糖尿病周围神经病变(DPN)患病风险的相关性。方法 回顾性选取2016年11月至2021年11月于我院就诊的T2DM患者200例,根据是否合并DPN分为T2DM合并DPN(DPN,n=87)组及单纯T2DM组(n=113),另选取同期就诊于我院的60例T2DM患者为验证组,其中26例合并DPN。多元Cox回归分析T2DM患者发生DPN的危险因素,构建列线图预测模型,受试者工作特征(ROC)曲线和校准曲线评价模型的预测效能。对所有患者随访1年,根据是否新发DPN将T2DM组分为新发DPN亚组(n=51)和无DPN亚组(n=62)。比较NLR变化对新发DPN的风险及神经传导速度的影响。结果 DM病程(HR 2.358,95%CI 1.754~3.658)、TG(HR 3.085,95%CI 2.454~6.778)、基线NLR(HR 3.145,95%CI1.466~5.632)是T2DM患者发生DPN的影响因素,列线图模型具有良好的区分度和准确性。NLR升高(HR 3.258,95%CI 1.678~4.694)和基线高NLR(HR 2.365,95%CI 1.547~4.526)是T2DM患者1年后新发DPN的独立危险因素,T2DM组NLR与神经传导速度呈负相关(P<0.05)。结论基线NLR正常水平越高,DPN发病风险越大,神经传导速度越慢,不利于患者预后。

Objective To investigate the association between baseline normal neutrophil/lymphocyte ratio(NLR)changes and the risk of diabetic peripheral neuropathy(DPN). Methods A total of 200 type 2 diabetes mellitus(T2DM) patients admitted to our hospital from November 2016 to November 2021 were retrospectively selected. They were divided into DPN group(87 cases)and T2DM group(113 cases)according to whether peripheral neuropathy was present. In the verification group, there were 26 T2DM patients combined with DPN. Multivariate Cox regression analysis was used to analyze the risk factors affecting DPN. A homogram prediction model was constructed. Receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive efficiency of the model. All patients were followed up for 1 year to compare the effects of changes in NLR on the risk of new DPN and nerve conduction velocity. Results DM duration(HR 2. 358,95%CI 1. 754~3. 658),triglyceride(HR 3. 085,95%CI 2. 454~6. 778),baseline NLR(HR 3. 145,95%CI 1. 466~5. 632)were risk factors for DPN. The model of line graph has good distinction and accuracy. Elevated NLR(HR 3. 258,95%CI 1. 678~4. 694)and high baseline NLR(HR 2. 365,95%CI 1. 547~4. 526)were independent risk factors for new DPN after 1 year in the DPN-free group(P<0. 05). There is a significant negative correlation between NLR and nerve conduction velocity in patients with T2DM(P<0. 05). Conclusions Within the baseline normal range,the higher the NLR ratio,the greater the risk of DPN and the slower nerve conduction velocity,which is not conducive to the prognosis of patients.