临床新型炎症指标对糖尿病肾脏疾病辅助诊断价值的研究  

Clinical value of new inflammatory indicators in the diagnosis of diabetic kidney disease

作　　者：刘丽[1] 张巧玲 杨红梅 袁宝军[1] 杨宏秀[1] 张会芬[1] 刘蕾[1] 郭智慧 LIU Li;ZHANG Qiaoling;YANG Hongmei(Department of Clinical Laboratory,Kailuan General Hospital,Tangshan 063100,China)

机构地区：[1]开滦总医院检验科,唐山063100 [2]开滦总医院内分泌科,唐山063100

出　　处：《中国糖尿病杂志》2023年第3期181-186,共6页Chinese Journal of Diabetes

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、血小板/淋巴细胞比值(PLR)、系统性免疫性炎症指数(SII)、全系统性炎症反应指数(SIRI)对早期DKD的诊断价值。方法 选取2020年1月至2021年8月于我院内分泌科治疗的T2DM患者250例,按UACR和eGFR将患者分为单纯T2DM组[T2DM,UACR<30 mg/g且eGFR≥90 ml/(min·1.73 m^(2)),n=107]、早期DKD组[EDKD,30≤UACR<300 mg/g且eGFR≥60 ml/(min·1.73 m^(2)),n=174]、临床DKD组[DKD,UACR≥300 mg/g或eGFR<60 ml/(min·1.73 m^(2)),n=69]。同期选取我院体检健康者168名为正常对照(NC)组。检测超敏C反应蛋白(hs-CRP),计算NLR、MLR、PLR、SII、SIRI。结果 与T2DM组比较,EDKD组NLR、MLR、SIRI升高(P<0.05)。与EDKD组比较,DKD组FPG、HbA1c、BUN、血肌酐、SUA、hs-CRP、NLR、PLR、SII、SIRI升高(P<0.05)。Pearson相关分析显示,NLR、MLR、PLR、SII、SIRI与UACR、hs-CRP呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。受试者工作特征曲线分析显示,SIRI+hs-CRP诊断性能较好,特异度最高(93.09%),联合检测未提高早期DKD诊断性能。结论 NLR、MLR、SIRI可早期诊断DKD,其中NLR、SIRI用于监测DKD,SIRI+hs-CRP联合检测对早期DKD有更好的诊断性能。Objective To investigate the diagnostic value of neutrophil to lymphocyte ratio(NLR),monocyteto lymphocyte ratio(MLR),platelet to lymphocyte ratio(PLR),systemic immune-inflammation index(SII),and systemic inflammation response index(SIRI)for early diabetic kidney disease(DKD).Methods A total of 250 patients with type 2 diabetes mellitus(T2DM)admitted to Endocrinology Department of our hospital were enrolled in this study from January 2020 to August 2021.All the patients were divided into three groups:simple T2DM group[T2DM group,UACR<30 mg/g and eGFR≥90 ml/(min·1.73 m^(2)),n=107],early DKD group[EDKD group,30≤UACR<300 mg/g and eGFR≥60 ml/(min·1.73 m^(2)),n=174],and clinical DKD group[DKD group,UACR≥300 mg/g or eGFR<60 ml/(min·1.73 m^(2)),n=69]according to UACR and eGFR.During the same period,168 healthy subjects were selected as normal control group(NC)from physical examination center.High-sensitivity C-reactive protein(hs-CRP),NLR,MLR,PLR,SII,and SIRI were detected and calculated.Results Compared with T2DM group,NLR,MLR and SIRI were increased in EDKD group(P<0.05).Compared with EDKD group,FPG,HbA1c,BUN,Scr,SUA,hs-CRP,NLR,PLR,SII and SIRI were increased in DKD group(P<0.05).Pearson correlation analysis showed that NLR,MLR,PLR,SII,SIRI were positively correlated with UACR and hs-CRP(P<0.05),while negatively correlated with eGFR(P<0.05).According to the ROC curve analysis,SIRI+hs-CRP had better diagnostic performance and the highest specificity(93.09%).The three and four combined tests did not significantly improve the diagnostic performance of early DKD.Conclusion NLR,MLR and SIRI can be used as markers for the early diagnosis of DKD.Among them,NLR and SIRI can be used to monitor DKD.SIRI combined with hs-CRP showed a better diagnostic effect for early DKD.

关 键 词：糖尿病肾脏疾病 中性粒细胞/淋巴细胞比值 单核细胞/淋巴细胞比值 血小板/淋巴细胞比值 系统性免疫性炎症指数 全系统性炎症反应指数 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]