中性粒细胞与淋巴细胞比值在糖尿病肾病中的变化及对早期糖尿病肾病的预测价值  

Changes of neutrophil-lymphocyte-ratio in diabetic nephropathy and its predictive value forearly-stage diabetic nephropathy

作　　者：叶晓梅 张敏 曹含弘 金海英 王萍 许伟伟 Ye Xiaomei;Zhang Min;Cao Hanhong(Department of Endocrinology,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院内分泌科,上海201700

出　　处：《临床内科杂志》2018年第9期602-605,共4页Journal of Clinical Internal Medicine

基　　金：上海市青浦区卫生和计划生育委员会项目（W2016-01）

摘　　要：目的 研究中性粒细胞与淋巴细胞比值（NLR）在2型糖尿病肾病（DN）中的变化及与早期DN的相关性,初步探讨NLR对早期DN的预测价值.方法 选取292例2型糖尿病患者,根据24 h尿白蛋白定量分为单纯糖尿病组（单纯DM组）、早期DN组及临床DN组,以健康体检者100例作为对照组,检测血常规及其他炎症指标、生化指标,计算NLR并比较其在各组间的差异.采用受试者工作特征（ROC）曲线评估NLR对早期DN的预测价值,logistic回归分析评估NLR与早期DN的关系.结果 NLR水平在对照组、单纯DM组、DN组（包括早期DN组及临床DN组）中依次升高（P〈0.05）,早期DN组与临床DN组NLR比较差异无统计学意义（P〉0.05）.NLR预测早期DN的截断值为2.43,ROC曲线下面积为0.676（95％CI 0.609-0.743,P〈0.001）,敏感度为73.3％,特异度为72.9％.Logistic回归分析结果显示,NLR、糖化血红蛋白（HbA1c）、病程、甘油三酯、低密度脂蛋白胆固醇升高是早期DN的独立危险因素.结论 DN患者NLR升高,NLR是早期DN的独立危险因素,可作为早期DN的一项预测指标.Objective To investigate the alteration of neutrophil-lymphocyte-ratio （NLR） in type 2 diabetic nephropathy （DN） and its association with early-stage DN and preliminarily explore its predictive value for early-stage DN. Methods A total of 292 patients with type 2 diabetes were included in this study. They were divided into simple diabetes group, early-stage DN group and overt DN group according to 24h-urinary albumin excretion. A total of I00 healthy subjects were selected as control group. Routine blood test, inflammatory markers and other biochemistry indexes were examined. NLR was calculated and compared among 4 groups. Receiver operating characteristic （ ROC ） curve was used to evaluate the predictive value of NLR for early-stage DN, and logistic regession model was used to assess the relationship between NLR and early-stage DN. Results The level of NLR increased successively in control group, simple diabetes group and DN groups（ including early-stage DN group and overt DN group,P 〈 0.05 ）. No significant difference was found between early-stage DN group and overt DN group （ P 〉 0.05 ）. The optimal cut-off point for NLR level to distinguish patients with early-stage DN from those without was 2.43, the area under ROC curve （AUC） was 0. 676 （95% CI O. 609-0. 743,P 〈 0.001 ） , with a sensitivity of 73.3% and a specificity of 72.9%. Logistic regession analysis showed that the independent risk factors for early-stage DN were increasing NLR, glycosylated hemoglobin Alc（ HbAle）, duration of disease, triglyeeride and low density lipoprotein cholesterol. Conclusion The NLR level is increased in DN. NLR is an independent risk factor for early-stage DN and it can be used as a predictive marker for early-stage DN.

关 键 词：中性粒细胞与淋巴细胞比值 糖尿病肾病 预测价值 

分 类 号：R587.2[医药卫生—内分泌]