中性粒细胞/淋巴细胞比值与原发性高血压患者早期肾功能损害的相关性分析  

Correlation between neutrophil to lymphocyte ratio and early-stage renal function damage in patients with essential hypertension

作　　者：刘建峰[1,2] 武艺[3] 华琦[1] 朱玮玮[1] 罗鸿宇[1] 郝鹏[1] 李敬[1] 王钢[1] 

机构地区：[1]首都医科大学宣武医院心脏科,北京100053 [2]北京市利康医院住院部 [3]首都医科大学康复医学院中国康复研究中心北京博爱医院心内科

出　　处：《山西医科大学学报》2015年第9期914-919,共6页Journal of Shanxi Medical University

基　　金：国家高科技发展计划(863计划)资助项目(2012AA02A516)

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与原发性高血压患者早期肾功能损害的关系。方法入选350例新诊断未经治疗的原发性高血压患者作为高血压组,另选同期年龄相当的180例体检健康者为对照组。采用简化肾脏病膳食改良试验(MDRD)方程估算肾小球滤过率(estimated glomerular filtration rate,e GFR),并根据e GFR值将高血压患者分为两组:肾功能受损组[e GFR<90 ml/(min·1.73 m2)]94例和肾功能正常组[e GFR≥90 ml/(min·1.73 m2)]256例。所有受试者均检测超敏C反应蛋白(hs-CRP)及外周血常规并计算NLR。结果 1与对照组比较,高血压组的NLR水平、hs-CRP、尿酸(UA)、尿微量白蛋白(MAU)升高,差异有统计学意义(P<0.05)。在高血压患者中,肾功能受损组的NLR明显高于肾功能正常组。2Pearson相关性分析显示,高血压组患者NLR与e GFR呈显著负性相关(r=-0.472,P<0.05)。经多因素Logistic回归分析,在校正了体重指数、脉压差、UA、hs-CRP及MAU后,NLR仍是原发性高血压患者早期肾功能损害的独立危险因素(OR=3.822,95%CI:2.167-6.739,P<0.05)。3受试者工作特征曲线(ROC曲线)显示NLR的曲线下面积为0.812(95%CI:0.782-0.880),且当NLR切点值取2.24时,其诊断效能最高,敏感性为73.4%,特异性76.2%。结论原发性高血压患者NLR水平的变化可能反映了肾功能的变化;NLR可能是原发性高血压患者早期肾功能损伤的独立危险因素。Objective To investigate the relationship between neutrophil to lymphocyte ratio（NLR） and early-stage renal function dam- age in patients with newly diagnosed essential hypertension. Methods A total of 350 patients with newly diagnosed and untreated essen- tial hypertension were enrolled as hypertension group ,and 180 healthy subjects were chosen as control group. The estimated glomerular fil- tration rate（eGFR） was assessed using the abbreviated equation of the modification diet for renal disease（MDRD） study. The patients with hypertension were divided into two groups： renal function deficit group（ eGFR 〈 90, n = 94） and normal renal functoin group （eGFR ≥90,n=256）. Results ①NLR,uric acid（UA）, hypersensitive C-reactive protein（hs-CRP） and micro-albumin urine（MAU） were significantly higher in hypertension group than in control group （P 〈 0.05）. The NLR in renal function deficit group was significantly higher than in normal renal function gronp（P 〈0. 05）. ②There was a statistically significant correlation between NLR and eGFR in hy- pertensive patients（ r = 0. 472 ,P 〈 0. 05）. The mtdtivariate Logistic regression analysis showed that NLR was an independent risk predictor of early-stage renal function damage in essential hypertensive patients （OR = 3. 822,95% C1：2. 167 -6.739 ,P 〈 0.05 ）. ③The receiver- operating characteristic curve analysis showed that an NLR value of 2.24 was an effective cut point in predicting renal function deficit with sensitivity and specificity of 73.4% and 76.2% （ AUC = 0.831,95 % CI ： O. 782 - 0.880）. Conclusion Changes of NLR levels may re- flect the changes of renal function in patients with hypertension. NLR may be utilized as a clinical predictive indicator for early-stage re- nal function damage in hypertension patients.

关 键 词：原发性高血压 中性粒细胞/淋巴细胞比值 估算肾小球率过滤 早期肾功能损害 

分 类 号：R544.1[医药卫生—心血管疾病]