中性粒与淋巴细胞比值与2型糖尿病肾病的相关性  

Relationship between neutrophils to lymphocytes ratio and type 2 diabetic kidney disease

作　　者：张宝玉[1] 孙荣欣[1] 石威[1] 赵冬[1] 夏维波 ZHANG Baoyu;SUN Rongxin;SHI Wei;ZHAO Dong;XIA Weibo(Department of Endocrinology,Beijing Luhe Hospital,Capital Medical University Beijing Key Laboratory of Diabetes Research and Care,Beijing 101149,China;Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College Endocrine Key Laboratory of the Former Health Ministry of China,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京潞河医院内分泌科北京市糖尿病防治重点实验室,北京101149 [2]中国医学科学院北京协和医院内分泌科原卫生部内分泌重点实验室,北京100730

出　　处：《中国医药导报》2019年第4期83-87,共5页China Medical Herald

基　　金：首都卫生发展科研专项(首发2016-3-7081)

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)与2型糖尿病肾病(DKD)的相关性。方法选取2012年7月～2018年6月于北京潞河医院住院治疗的2型糖尿病患者148例,根据患者8 h尿微量白蛋白排泄率(8°UAER)分为5组:8°UAER<20μg/min、血清肌酐正常30例为DM1组;20μg/min≤8°UAER<200μg/min、血清肌酐正常30例为DM2组;8°UAER≥200μg/min、血清肌酐正常28例为DM3组;8°UAER≥200μg/min、血清肌酐>120μmol/L但尚未透析者29例为DM4组;DM5组为临床诊断DKD行血液透析治疗患者,共31例。选取健康对照者29名为对照组(N组)。空腹静脉采血,检测各组血常规、血糖、血脂、肝肾功,DM1、DM2、DM3、DM4组留取8 h尿,检测8°UAER。结果随着DKD进展,NLR逐渐升高,DM4、DM5组高于N、DM1、DM2、DM3组(P <0.05或P <0.01),DM3组高于N组和DM1组(P <0.05)。Pearson相关分析结果显示NLR与年龄(r=0.317,P <0.001)、病程(r=0.306,P <0.001)、8°UAER(r=0.293,P=0.006)、尿素氮(r=0.404,P <0.001)、全段甲状旁腺激素(iPTH)(r=0.465,P <0.001)呈正相关,与肾小球滤过率(r=-0.438,P <0.001)、白蛋白(r=-0.194,P=0.019)、高密度脂蛋白胆固醇(r=-0.182,P=0.028)呈负相关。多元线性回归方程:YLog NLR=0.29+0.54Log8°UAER+0.004年龄(R2=0.152,P=0.001);ROC曲线显示,以NLR=2.29作为切点,诊断DKD的灵敏度和特异度分别为52.6%、73.3%(ROC曲线下面积是0.661,95%CI:0.544～0.779,P=0.014)。结论 NLR在DKD进展过程中逐渐升高,在临床蛋白尿的2型糖尿病患者中显著升高,与8°UAER呈正相关,但NLR升高晚于8°UAER,提示NLR升高可预测DKD的发生。Objective To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR)and type 2 diabetic kidney disease(DKD).Methods A total of 148 patients with type 2 diabetes mellitus admitted to Beijing Luhe Hospital from July 2012 to June 2018,and they were divided into 5 groups according to urine albumer excretion rate in 8 h(8°UAER).Thirty patients with 8°UAER<20μg/min and normal serum creatinine were DM1 group;30 patients with 20μg/min≤8°UAER<200μg/min and normal serum creatinine were DM2 group;28 patients with 8°UAER≥200μg/min and normal serum creatinine were DM3 group;29 patients with 8°UAER≥200μg/min and serum creatinine >120μmol/L,not yet been dialysis were DM4 group;31 patients diagnosed as DKD and been dialysis were DM5 group.Twenty-nine health control individuals were selected as control group(N group).Blood was collected by fasting vein.Blood routine examination,glucose,lipid,liver and kidney function were examined in each group.Eight-hour urine in DM1,DM2,DM3 and DM4 group were collected and 8°UAER were detected.Results NLR gradually increased in DKD progress and NLR in DM4 and DM5 group were higher than that in N,DM1,DM2,DM3 group(P<0.05 or P<0.01),NLR in DM3 group was higher than that in N and DM1 group(P<0.05).The results of Pearson correlation analysis showed that NLR was positively correlated with age(r=0.317,P<0.001),course of disease(r=0.306,P<0.001),8°UAER(r=0.293,P=0.006),urea nitrogen(r=0.404,P<0.001),total parathyroid hormone(iPTH)(r=0.465,P<0.001)and was negatively correlated with glomerular filtration rate(r=-0.438,P<0.001),albumin(r=-0.194,P=0.019),high-density lipoprotein cholesterol(r=-0.182,P=0.028).Multiple linear regression equation:YLogNLR=0.29+0.54Log8°UAER+0.004 age(R2=0.152,P=0.001).ROC curve showed NLR=2.29 as the cut point,and the sensitivity and specificity of DKD diagnosis were 52.6%and 73.3%(area under the ROC curve is 0.661,95%CI:0.544-0.779,P=0.014).Conclusion NLR gradually increases during the progression of diabetic nephropathy,and is significan

关 键 词：糖尿病肾病 中性粒细胞与淋巴细胞比值 2型糖尿病 8h尿微量白蛋白排泄率 

分 类 号：R587.2[医药卫生—内分泌]