慢性肾脏病5期非透析患者中性粒细胞/淋巴细胞比值与肺动脉高压的相关性研究

冯世尧; 任伟

doi:10.3969/j.issn.1671-2390.2020.10.008

慢性肾脏病5期非透析患者中性粒细胞/淋巴细胞比值与肺动脉高压的相关性研究

冯世尧,
任伟

Relationship between neutrophil-to-lymphocyte ratio and pulmonary arterial hypertension in non-dialytic patients with chronic kidney disease stage 5

摘要

摘要: 目的探讨慢性肾脏病（chronic kidney disease，CKD）5期非透析患者中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）对肺动脉高压（pulmonary arterial hypertension，PAH）的临床价值。方法选取CKD 5期非透析患者144例，根据肺动脉收缩压水平分为肺动脉高压组和无肺动脉高压组。比较两组患者临床资料，采用Spearman相关分析肺动脉收缩压与各因素之间的关系，采用二分类Logistic回归分析PAH发生的危险因素，采用ROC曲线评估NLR对PAH预测价值。结果肺动脉高压组64例（44.4%），无肺动脉高压组80例（55.6%）。肺动脉高压组NLR、血小板与淋巴细胞比值、左房内径、主肺动脉内径明显高于无肺动脉高压组，肺动脉高压组淋巴细胞计数、血红蛋白、血清铁、甘油三酯、极低密度脂蛋白胆固醇、左室射血分数明显低于无肺动脉高压组，差异均有统计学意义（P<0.05）。NLR、左房内径、主肺动脉内径与肺动脉收缩压呈正相关（P<0.05）。多因素Logistic分析结果显示，NLR（OR=2.151，95%CI 1.438~3.218，P<0.001）、左房内径（OR=1.176，95%CI 1.068~1.294，P<0.05）、主肺动脉内径（OR=1.229，95%CI 1.004~1.504，P<0.05）为PAH独立危险因素。ROC曲线分析结果显示，NLR预测PAH的曲线下面积为0.711（95%CI 0.626~0.797，P<0.05），当NLR截断值为3.23时，预测CKD 5期非透析患者发生PAH的敏感度和特异性分别为60.9%和72.5%。结论 NLR对预测CKD 5期非透析患者发生PAH具有较好的临床应用价值，左房扩大和主肺动脉增宽与PAH有关。

Abstract: Objective To investigate the clinical value of neutrophil-to-lymphocyte ratio(NLR)for pulmonary arterial hypertension(PAH)in non-dialytic patients with chronic kidney disease(CKD) stage 5.Methods A total of 144 non-dialysis patients with CKD stage 5 were divided into two groups:PAH group and non-PAH group according to pulmonary artery systolic pressure.Clinical data were compared between the two groups,Spearman correlation analysis was used to analyze the relationship between pulmonary artery systolic pressure and various factors.Binary classification Logistic regression analysis was applied to analyze the risk factors of PAH.Receiver operating characteristic(ROC)curve was adopted to evaluate the predictive value of NLR for PAH.Results There were 64 cases(44.4%)in the PAH group and 80 cases(55.6%)in the non-PAH group.NLR,platelet to lymphocyte ratio,left internal atrial diameter and main pulmonary internal artery diameter in the PAH group were significantly higher than those in the non-PAH group(P<0.05).Lymphocyte count,hemoglobin,serum iron,triglyceride,very low density lipoprotein cholesterol and left ventricular ejection fraction in the PAH group were significantly lower than those in the non-PAH group,with all statistically significant differences(P<0.05).NLR,left atrial diameter and main pulmonary artery diameter were positively correlated with pulmonary artery systolic pressure(P<0.05).Multivariate Logistic analysis showed that,NLR(OR=2.151,95%CI 1.438~3.218,P<0.001),left atrial diameter(OR=1.176,95%CI 1.068~1.294,P<0.05)and main pulmonary artery diameter(OR=1.229,95%CI 1.004~1.504,P<0.05)were independent risk factors for PAH.The results of ROC curve analysis showed that the area under curve of PAH predicted from NLR was 0.711(95% CI 0.626~0.797,P<0.05).When the NLR cutoff value was 3.23,the sensitivity and specificity for predicting the occurrence of PAH in non-dialysis patients with CKD stage 5 were 60.9% and 72.5%,respectively.Conclusions NLR has a good clinical value in predicting the occurrence of PAH in non-dialysis patients with CKD stage 5.Left atrial enlargement and main pulmonary artery enlargement were related to PAH.

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