NLR、PLR、MLR及CysC对不同原发病肾透析患者死亡率的影响  

Effects of NLR,PLR,MLR and CysC on mortality of maintenance hemodialysis patients with different primary kidney dialysis

作　　者：樊瑞瑞 原平玫 万道侠 曲丽梅 胡涛 FAN Ruirui;YUAN Pingmei;WAN Daoxia;QU Limei;HU Tao(Department of Immunology,School of Basic Medicine,Binzhou Medical University,Yantai 264003,Shandong,P.R.China;Fushan Center for Disease Control and Prevention,Yantai 265500,Shandong,P.R.China;Department of Clinical Laboratory,Yeda Hospital,Yantai 265503,Shandong,P.R.China;College of Statistics,Shandong University of Finance and Economics,Jinan 250014,Shandong,P.R.China)

机构地区：[1]滨州医学院基础医学院免疫学教研室,山东烟台264003 [2]烟台市福山区疾病预防控制中心,山东烟台265500 [3]烟台业达医院检验科,山东烟台265503 [4]山东财经大学统计学院,山东济南250014

出　　处：《滨州医学院学报》2022年第2期100-105,111,共7页Journal of Binzhou Medical University

摘　　要：目的探讨不同原发病肾透析患者血常规、生化指标,血液中性粒细胞与淋巴细胞比值(NLR),血小板与淋巴细胞比值(PLR),淋巴细胞与单核细胞比值(MLR),以及维持性血液透析(MHD)时间与患者死亡之间的关系。方法选择2020年11月于烟台业达医院血液净化中心接受MHD治疗、病情稳定,原发病为糖尿病肾病(DN)和慢性肾小球肾炎(CGN)患者95例;根据原发病分两组,比较两组患者年龄、血常规等相关指标之间的差异。随访10个月,观察生存情况。应用logistic回归分析影响DN和CGN患者死亡的危险因素;并利用受试者工作特征曲线(ROC)确定相应危险因素的敏感度、特异度及临界值。结果DN组和CGN组多项纳入指标存在差异。DN组中,死亡患者NLR、MLR、PLR、C-反应蛋白(hs-CRP)均高于生存患者,P<0.01,淋巴细胞(L)低于生存患者,P<0.01。CGN组中死亡患者白细胞(WBC)、中性粒细胞(N)、单核细胞(M)、NLR、MLR、PLR、hs-CRP、磷(P)、尿酸(UA)均高于生存患者,P<0.05或<0.01。NLR、L可作为DN患者死亡的危险因素。DN组NLR的ROC曲线下面积为0.925,P<0.01,NLR≥4.01时灵敏度为1,特异度为0.8。1/L的ROC曲线下面积为0.776,P<0.01,当1/L≥0.905时,灵敏度为0.750,特异度为0.756。结论CGN组患者男性占比,透析月龄、死亡率及血液MLR、P、尿素(BUN)、肌酐(CREA)、血清胱抑素C(CysC)、UA、Fe蛋白均高于DN组。NLR和L可作为预测DN患者接受MHD治疗发生死亡的独立危险因素,其中NLR的临界值为4.01。objective To investigate the relationship between blood routine,biochemical indexes,neutrophils to lymphocyte ratio(NLR),platelet to lymphocytes ratio(PLR),monocyte to lymphocyte ratio(MLR),duration of maintainance Hemodialysis(MHD)and mortality of patients.Methods Ninety-five patients with diabetic nephropathy(DN)and chronic glumerulonephritis nephropathy(CGN)who received MHD treatment in stable condition in the Blood Purification Center of Yantai Yeda Hospital were enrolled in this study.The patients were divided into two groups according to the primary disease,and the differences of age,blood routine and other related indexes were compared between the two groups.The patients were followed up for 10 months to observe the survival.Logistic regression was used to analyze the risk factors of death in DN and CGN patients.Receiver operating characteristic curve(ROC)was used to determine the sensitivity,specificity and critical value of the risk factors.Results There were differences in multiple inclusion indexes between the DN group and the CGN group.In the DN group,NLR,MLR,PLR and hs-CRP of dead patients were higher than those of living patients,P<0.01,while L was lower than that of living patients,P<0.01.In the CGN group,WBC,N,M,NLR,MLR,PLR,hs-CRP,P and UA of dead patients were higher than those of living patients,P<0.05 or<0.01.NLR and L can be used as risk factors of death in DN patients.The area under ROC curve of NLR in the DN group was 0.925(P<0.01),and with NLR≥4.01,the sensitivity was 1,the specificity was 0.8.The area under ROC curve of 1/L was 0.776(P<0.01),with 1/L≥0.905,the sensitivity was 0.750,and the specificity was 0.756.Conclusion The male proportion,the months of dialysis,mortality and MLR,P,BUN,CREA,CysC,UA and Fe proteins in blood were higher in the CGN group than those in the DN group.NLR and L can be used as independent risk factors for predicting death in DN patients receiving MHD treatment,and the critical value of NLR was 4.01.

关 键 词：维持性血液透析 中性粒细胞/淋巴细胞比值 血小板与淋巴细胞比值 单核细胞与淋巴细比值 血清胱抑素C 

分 类 号：R446.1[医药卫生—诊断学]