中性粒与淋巴细胞比值与2型糖尿病肾病的相关性

摘要
图/表
参考文献(21)
相关文章 (15)

全文: PDF (572 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

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＜20 μg/min、血清肌酐正常30例为DM1组；20 μg/min≤8°UAER＜200 μg/min、血清肌酐正常30例为DM2组；8°UAER≥200 μg/min、血清肌酐正常28例为DM3组；8°UAER≥200 μg/min、血清肌酐＞120 μmol/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：YLogNLR = 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。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	张宝玉1 孙荣欣1 石威1 赵冬1▲ 夏维波2▲

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, 8 h尿微量白蛋白排泄率

Abstract：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＜20 μg/min and normal serum creatinine were DM1 group; 30 patients with 20 μg/min≤8°UAER＜200 μg/min and normal serum creatinine were DM2 group; 28 patients with 8°UAER≥200 μg/min and normal serum creatinine were DM3 group; 29 patients with 8°UAER≥200 μg/min and serum creatinine＞120 μmol/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 significantly high in patients with type 2 diabetes mellitus with proteinuria. It is positively correlated with 8°UAER, but the increase of NLR is later than 8°UAER, suggesting that increasing NLR may predict the occurrence of diabetic kidney disease.

Key words： Diabetic kidney disease Neutrophils to lymphocytes ratio Type 2 diabetes mellitus mellitus Urinary albumin excretion rate in 8 h

基金资助:首都卫生发展科研专项（首发2016-3-7081）。

通讯作者: ▲共同通讯作者

引用本文:

张宝玉1 孙荣欣1 石威1 赵冬1▲ 夏维波2▲. 中性粒与淋巴细胞比值与2型糖尿病肾病的相关性[J]. 中国医药导报, 2019, 16(4): 83-87.
ZHANG Baoyu1 SUN Rongxin1 SHI Wei1 ZHAO Dong1▲ XIA Weibo2▲. Relationship between neutrophils to lymphocytes ratio and type 2 diabetic kidney disease. 中国医药导报, 2019, 16(4): 83-87.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I4/83

[1] Cho NH，Shaw JE，Karuranga S，et al. IDF Diabetes Atlas：Global estimates of diabetes prevalence for 2017 and projections for 2045 [J]. Diabetes Res Clin Pract，2018，138：271-281.
[2] Wang L，Gao P，Zhang M，et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013 [J]. Jama，2017，317（24）：2515-2523.
[3] Nelson RG，Tuttle KR. The new KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and CKD [J]. Blood Purif，2007，25（1）：112-114.
[4] Donath MY. Targeting inflammation in the treatment of type 2 diabetes： time to start [J]. Nat Rev Drug Discov，2014， 13（6）：465-476.
[5] Ahsen A，Ulu MS，Yuksel S，et al. As a new inflammatory marker for familial Mediterranean fever：neutrophil-to-lymphocyte ratio [J]. Inflammation，2013，36（6）：1357-1362.
[6] Imtiaz F，Shafique K，Mirza SS，et al. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population [J]. Int Arch Med，2012，5（1）：2.
[7] Alberti KG，Zimmet PZ. Definition，diagnosis and classification of diabetes mellitus and its complications. Part 1：diagnosis and classification of diabetes mellitus provisional report of a WHO consultation [J]. Diabet Med，1998，15（7）：539-553.
[8] Reidy K，Kang HM，Hostetter T，et al. Molecular mechanisms of diabetic kidney disease [J]. J Clin Invest，2014， 124（6）：2333-2340.
[9] Rabbani N，Thornalley PJ. Advanced glycation end products in the pathogenesis of chronic kidney disease [J]. Kidney Int，2018，93（4）：803-813.
[10] Alicic RZ，Johnson EJ，Tuttle KR. Inflammatory Mechanisms as New Biomarkers and Therapeutic Targets for Diabetic Kidney Disease [J]. Adv Chronic Kidney Dis，2018，25（2）：181-191.
[11] Sangoi MB，de Carvalho JA，Tatsch E，et al. Urinary inflammatory cytokines as indicators of kidney damage in type 2 diabetic patients [J]. Clin Chim Acta，2016，460：178-183.
[12] Jha JC，Banal C，Chow BS，et al. Diabetes and Kidney Disease：Role of Oxidative Stress [J]. Antioxid Redox Signal，2016，25（12）：657-684.
[13] Turkmen K. Inflammation，oxidative stress，apoptosis，and autophagy in diabetes mellitus and diabetic kidney disease：the Four Horsemen of the Apocalypse [J]. Int Urol Nephrol，2017，49（5）：837-844.
[14] Szablewski L，Sulima A. The structural and functional changes of blood cells and molecular components in diabetes mellitus [J]. Biol Chem，2017，398（4）：411-423.
[15] Liu X，Zhang Q，Wu H，et al. Blood Neutrophil to Lymphocyte Ratio as a Predictor of Hypertension [J]. Am J Hypertens，2015，28（11）：1339-1346.
[16] Mertoglu C，Gunay M. Neutrophil-Lymphocyte ratio and Platelet-Lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus [J]. Diabetes Metab Syndr，2017，11（Suppl 1）：S127-S131.
[17] Verdoia M，Schaffer A，Barbieri L，et al. Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship to coronary artery disease [J]. Diabetes Metab，2015，41（4）：304-311.
[18] Afsar B. The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with type 2 diabetes [J]. Am J Med Sci，2014，347（3）：217-220.
[19] Huang W，Huang J，Liu Q，et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy [J]. Clin Endocrinol（Oxf），2015，82（2）：229-233.
[20] Chung FM，Tsai JC，Chang DM，et al. Peripheral total and differential leukocyte count in diabetic nephropathy：the relationship of plasma leptin to leukocytosis [J]. Diabetes Care，2005，28（7）：1710-1717.
[21] Lorenzo C，Hanley AJ，Haffner SM. Differential white cell count and incident type 2 diabetes：the Insulin Resistance Atherosclerosis Study [J]. Diabetologia，2014，57（1）：83-92.