中性粒细胞-淋巴细胞比率、血小板-淋巴细胞比率与血液透析患者动静脉瘘狭窄的关系  

Correlations of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with arteriovenous fistula stenosis in hemodialysis patients

作　　者：刘佳丽[1] 张和平[2] 段志强 李栋 杨琨 Liu Jiali;Zhang Heping;Duan Zhiqiang;Li Dong;Yang Kun(Department of Clinical Medicine,North Sichuan Medical College;Department of Nephrology,Affiliated Hospital of North Sichuan Medical College;Department of Nephrology,Air Force Hospital of Western Theater Command;Chengdu Gaoxin Boli Hospital)

机构地区：[1]川北医学院临床医学系,南充637000 [2]川北医学院附属医院肾内科,南充637000 [3]西部战区空军医院肾内科,成都610021 [4]成都高新博力医院,成都610021

出　　处：《重庆医科大学学报》2025年第3期416-420,共5页Journal of Chongqing Medical University

基　　金：南充市社会科学研究“十四五”规划资助项目(编号:NC22C248);南充市2020年市校科技战略合作专项课题资助项目(编号:20SXQT0287)。

摘　　要：目的:探讨中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)和血小板-淋巴细胞比值(plateletlymphocyte ratio,PLR)与血液透析(hemodialysis,HD)患者动静脉内瘘(arteriovenous fistula,AVF)狭窄的关系。方法:收集2021年1月至2022年6月在川北医学院附属医院肾内科就诊的625例使用动静脉内瘘透析的患者资料,其中资料完善且符合纳入标准的患者395例,有AVF狭窄的患者245例被分为1组,无AVF狭窄的患者150例为2组。记录患者的常规生化值和全血细胞计数值。结果:①1组患者NLR5.07(4.00,6.66)vs.3.46(2.63,4.15),PLR169.52(127.56,227.11)vs.125.66(89.31,165.31)及超敏C-反应蛋白(C-reactive protein,Hs-CRP)1.90(0.80,2.99)vs.0.82(0.42,1.27),水平均高于2组患者,差异有统计学意义(均P<0.001)。②多因素logistic回归分析,校正年龄、性别、体质指数(body mass lndex,BMI)、AVF吻合方式、穿刺方式、是否合并糖尿病等因素,结果显示NLR(OR=2.195,95%CI=1.674~2.878,P<0.001),PLR(OR=1.008,95%CI=1.002~1.012,P=0.007),Hs-CRP(OR=2.170,95%CI=1.607~2.751,P<0.001)三者均是HD患者AVF狭窄的独立危险因素。③接受者操作特性曲线(receiver operating characteristic curve,ROC)析显示,NLR曲线下面积(Area Under Curve,AUC)0.799(95%CI=0.756~0.838,P<0.001),PLR 0.694(95%CI=0.646~0.740,P<0.001),Hs-CRP 0.717(95%CI=0.670~0.761,P<0.001),三者均可预测AVF狭窄,预测最佳临界值分别为NLR 4.08,PLR 122.49,Hs-CRP 1.62,并且3个指标联合预测效果更佳(AUC 0.870,95%CI=0.833~0.901,P<0.001),灵敏度79.18%,特异度81.33%。结论:NLR、PLR和Hs-CRP均是AVF狭窄的独立危险因素和预测因子,且三者联合检测预测价值更高。Objective:To study the correlations of neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)with arteriovenous fistula(AVF)stenosis in hemodialysis(HD)patients.Methods:Data were collected from 625 patients who underwent arteriovenous fistula hemodialysis at the Department of Nephrology,Affiliated Hospital of North Sichuan Medical College between January 2021 and June 2022.Of these,395 eligible patients with complete information were selected as subjects of study.The 245 patients with AVF stenosis were designated as group 1 and the 150 patients without AVF stenosis were designated as group 2.The routine biochemical parameters and complete blood count were recorded for all patients.Results:①Compared with patients in group 2,those in group 1 showed significantly higher NLR(5.07(4.00,6.66)vs.3.46(2.63,4.15),P<0.001),PLR(169.52(127.56,227.11)vs.125.66(89.31,165.31),P<0.001),and C-reactive protein(Hs-CRP)(1.90(0.80,2.99)vs.0.82(0.42,1.27),P<0.001).②Multivariate logistic regression analysis,which was corrected for age,sex,body mass index,AVF anastomosis,puncture method,and diabetes,showed that NLR(OR=2.195,95%CI=1.674~2.878,P<0.001),PLR(OR=1.008,95%CI=1.002~1.012,P=0.007),and Hs-CRP(OR=2.170,95%CI=1.607~2.751,P<0.001)were independent risk factors for AVF stenosis in HD patients.③Receiver operating characteristic curve analysis showed that the area under the NLR curve(0.799,95%CI=0.756~0.838,P<0.001),PLR(0.694,95%CI=0.646~0.740,P<0.001),and Hs-CRP(0.717,95%CI=0.670~0.761,P<0.001)could be used to predict AVF stenosis.Their optimal critical values for prediction were 4.08,122.49,and 1.62,respectively.Their combination showed improved prediction effect(AUC 0.870,95%CI=0.833~0.901,P<0.001),high sensitivity(79.18%),and high specificity(81.33%).Conclusion:NLR,PLR,and Hs-CRP were independent risk factors and predictors of AVF stenosis,and their combination has higher predictive value.

关 键 词：动静脉内瘘 狭窄 中性粒细胞-淋巴细胞比率 血小板-淋巴细胞比率 血液透析 

分 类 号：R54[医药卫生—心血管疾病]