全血细胞计数和高密度脂蛋白胆固醇之比与急性胰腺炎相关急性肾损伤的临床研究

魏茂碧; 张治琴; 马洲; 吴小燕

doi:10.3969/j.issn.1671-2390.m20-147

全血细胞计数和高密度脂蛋白胆固醇之比与急性胰腺炎相关急性肾损伤的临床研究

Ratios of neutrophil,lymphocyte and monocyte to high-density lipoprotein cholesterol in acute pancreatitis complicated with acute kidney injury

摘要

摘要: 目的探讨入院中性粒细胞/高密度脂蛋白胆固醇比值（neutrophil-to-high density lipoprotein cholesterol ratio，NHR）、淋巴细胞/高密度脂蛋白胆固醇比值（lymphocyte-to-high density lipoprotein cholesterol ratio，LHR）和单核细胞/高密度脂蛋白胆固醇比值（monocyte-to-high density lipoprotein cholesterol ratio，MHR）对急性胰腺炎（acute pancreatitis，AP）相关急性肾损伤（acute pancreatitis-acute kidney injury，AP-AKI）的临床预测价值。方法本研究采用回顾性队列研究，分析武汉大学中南医院收治的302例确诊为AP患者的临床资料，按是否发生AKI分为AKI组和无AKI组（NAKI组），比较2组间临床资料的差异。结果共有65例患者发生了AKI，发病率为21.5%，其中AKI 1期32例（10.6%）、2期16例（5.3%）、3期17例（5.6%）。AKI组NHR、LHR、MHR显著高于NAKI组，差异具有统计学意义（Z值为7.356、5.062和6.446，P<0.01）。且在调整了基础肾功能、性别、伴随的慢性疾病、AP病因、入院基本生命体征以及血生化等指标后，多因素Logistic向前逐步回归分析发现：入院NHR （OR=1.081，95%CI 1.043~1.121，P<0.01）、MHR （OR=2.445，95%CI 1.514~3.947，P<0.01）、LHR （OR=1.713，95%CI 1.306~2.246，P<0.01）是AP-AKI的独立危险因素，ROC曲线显示上述指标对AP-AKI具有较好的预测价值，曲线下面积（area under the curve，AUC）分别为0.798、0.761和0.705（均P<0.01）。为进一步了解血脂水平对NHR、MHR、LHR关于AP-AKI预测价值的影响，行亚组分析显示上述指标在高脂血症组的AUC分别为0.709、0.667和0.615，在非高脂血症组的AUC分别为0.830、0.790和0.707，2组NHR、MHR、LHR之间AUC比较差异无统计学意义（均P>0.05）。此外，将患者住院期间行血管活性药物、机械通气和肾脏替代治疗定义为院内特殊治疗，满足上述之一者归为需行特殊治疗组。ROC曲线显示NHR、MHR、LHR对院内需行特殊治疗的AUC分别为0.782、0.702和0.679（均P<0.05），同时与用于衡量疾病严重程度的急性生理与慢性健康评分Ⅱ和全身炎症反应综合征评分也具有较好的相关性，提示上述指标对AP的病情严重程度也具有良好的预测价值。结论入院NHR、MHR、LHR作为全血细胞计数与高密度脂蛋白胆固醇结合的综合炎性反应指标，与AP的病情严重程度呈正相关，是AP-AKI的独立危险因素。

Abstract: Objective To explore the clinical predictive values of admission neutrophil,lymphocyte and monocyte to high-density lipoprotein cholesterol ratio(NHR/LHR/MHR)in acute pancreatitis(AP)related with acute kidney injury(AKI).Methods For this retrospective cohort study,a total of 302 AP patients were divided into AKI and non-AKI groups according to the KDIGO-AKI criteria.The inter-group differences of clinical profiles were compared for NHR,LHR and MHR.Results The incidence of AKI was 21.5%(65/302).And the clinical stage was 1(n=32,10.6%),2(n=16,5.3%)and 3(n=17,5.6%).NHR,LHR and MHR were markedly higher in AKI group than those in NAKI group and the difference were statistically significant(Z=7.356,5.062 & 6.446,P<0.01).After adjusting basic renal function,gender,concomitant chronic diseases,etiology of AP,basic vital signs and blood biochemical parameters on admission,multivariate logistic forward stepwise regression analysis revealed that admission NHR(OR=1.081,95%CI 1.043~1.121,P<0.01),MHR(OR=2.445,95%CI 1.514~3.947,P<0.01)and LHR(OR=1.713,95%CI 1.306~2.246,P<0.01)were the independent risks factors for AP-AKI.ROC curve indicated that the above parameters had excellent predictive values for AP-AKI and AUC were 0.798,0.761 and 0.705 respectively(all P<0.01).For understanding the impact of blood lipid levels on the predictive values of NHR,MHR,and LHR for AP-AKI,subgroup analysis showed that AUC of the above parameters were 0.709,0.667 and 0.615 in hyperlipidemic group and 0.830,0.790 and 0.707 in non-hyperlipidemic group respectively.No statistically significant inter-group differences existed in NHR,MHR or LHR(all P>0.05).Furthermore,vasopressors,mechanical ventilation and renal replacement therapy during hospitalization were defined as special hospital interventions.Fulfilling one of the above required special treatments.And the values of AUC were 0.782,0.702 and 0.679 respectively(all P<0.05).At the same time,it had an excellent correlation with APACHE II and SIRS scores for assessing the severity of AP.Conclusions Admission NHR,MHR,LHR as the comprehensive inflammatory parameters along with complete blood count and HDL-C are positively correlated with the severity of AP and serve as independent risk factors for AP-AKI.

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