甲状旁腺切除术对肾性继发性甲状旁腺功能亢进患者NLR、PLR的影响

刘甜甜; 陶舒曼; 王德光

doi:10.3969/j.issn.1671-2390.w20-114

甲状旁腺切除术对肾性继发性甲状旁腺功能亢进患者NLR、PLR的影响

安徽医科大学第二附属医院肾脏内科, 合肥 230601

基金项目:

安徽省自然科学基金（2008085MH244）；安徽医科大学校科研基金项目（2019xkj140）

详细信息

通讯作者:
王德光,Email:wangdeguang@ahmu.edu.cn

计量
- 文章访问数: 353
- HTML全文浏览量: 0
- PDF下载量: 280
出版历程
- 收稿日期: 2020-05-18
- 网络出版日期: 2023-05-11
- 发布日期: 2021-02-27
- 刊出日期: 2021-02-27

Effect of parathyroidectomy on NLR and PLR in patients with renal secondary hyperparathyroidism

Department of Nephrology, Second Affiliated Hospital, Anhui Medical University, Hefei 230601, China

Funds:

Anhui Provincial Natural Science Fund(2008085MH244)

摘要

摘要: 目的探讨甲状旁腺切除术对肾性继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHPT）患者中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、血小板/淋巴细胞比值（platelet-to-lymphocyte ratio，PLR）的影响，及NLR、PLR与贫血、血钙、血磷间的关系。方法选取2013年1月至2019年1月在安徽医科大学第二附属医院肾脏内科行甲状旁腺切除术的151例肾性SHPT患者。术后根据全段甲状旁腺素（intact parathyroid hormone，iPTH）水平分为手术成功组和持续性SHPT或复发性SHPT组，比较两组术后NLR、PLR等指标的变化。结果相关性分析提示术前NLR与白细胞计数、超敏C反应蛋白、血磷、钙磷乘积呈正相关（P<0.05）。术前PLR与血磷、钙磷乘积呈正相关（P<0.05），与血红蛋白呈负相关（P<0.05）。手术成功组中，与术前相比，血钙、血磷、NLR、PLR、iPTH明显下降，血红蛋白、红细胞计数、淋巴细胞计数较术前明显升高（P<0.05）。持续性SHPT或复发性SHPT组中，术后血钙、iPTH较术前下降（P<0.05），而NLR、PLR、血红蛋白等指标手术前后比较差异无统计学意义（P>0.05）。多因素回归分析结果显示术前NLR、PLR可分别预测手术前后NLR变化量、PLR变化量。结论成功的甲状旁腺切除术可以降低NLR和PLR，通过对全身炎症的调节作用，可能在一定程度上改善肾性SHPT患者的贫血及矿物质和骨代谢异常。
- 甲状旁腺切除术 /
- 继发性甲状旁腺功能亢进 /
- 中性粒细胞/淋巴细胞比值 /
- 血小板/淋巴细胞比值
Abstract: Objective To explore the effects of parathyroidectomy on neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in patients with renal secondary hyperparathyroidism(SHPT).Also the correlation was made between NLR、PLR and anemia,calcium and phosphorus,which provides clinical basis for improving anemia,mineral and bone disorder(MBD)and quality-of-life in SHPT patients.Methods A total of 151 patients with renal SHPT undergoing parathyroidectomy from January 2013 to January 2019 were recruited.According to the postoperative level of intact parathyroid hormone(iPTH),they were divided into two groups of successful and persistent or recurrent SHPT.The postoperative changes of NLR/PLR and other parameters were compared between two groups.Results Spearman’s correlation analysis indicated that preoperative NLR was positively correlated with white blood cell count,hypersensitive C-reactive protein,phosphorus,calcium and phosphorus product(P<0.05).Preoperative PLR was correlated positively with phosphorus,serum calcium and phosphorus product(P<0.05)and negatively with hemoglobin(P<0.05).In successful group,as compared preoperatively,serum levels of calcium,phosphorus,NLR/PLR,platelet count and iPTH decreased markedly while hemoglobin,red blood cell count and lymphocyte count rose obviously(P<0.05).In persistent or recurrent SHPT group,postoperative serum levels of calcium and iPTH decreased as compared preoperatively(P<0.05).No statistically significant difference existed in NLR/PLR,hemoglobin or other parameters before and after operation(P>0.05).Multi-factorial regression analysis revealed that preoperative NLR/PLR could predict the variations of NLR(ΔNLR)and PLR(ΔPLR).Conclusions Successful parathyroidectomy decreases NLR/PLR.And the modulatory effects of parathyroidectomy on systemic inflammation may improve the symptoms of anemia and MBD in patients with renal SHPT.
- Parathyroidectomy /
- Secondary hyperparathyroidism /
- Neutrophil-to-lymphocyte ratio /
- Platelet-to-lymphocyte ratio

HTML全文

参考文献(22)

[1]	Portillo MR,Rodríguez-Ortiz ME.Secondary hyperparthyroidism:pathogenesis,diagnosis,preventive and therapeutic strategies[J].Rev Endocr Metab Disord,2017,18(1):79-95.DOI: 10.1007/s11154-017-9421-4.
[2]	Carrero JJ,Stenvinkel P.Inflammation in end-stage renal disease:what have we learned in 10 Years?[J].Semin Dial,2010,23(5):498-509.DOI: 10.1111/j.1525-139X.2010.00784.x.
[3]	Wei YD,Lin J,Yang F,et al.Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease[J].Exp Ther Med,2016,12(2):1206-1212.DOI: 10.3892/etm.2016.3438.
[4]	Wang XD,Zhang GY,Jiang XJ,et al.Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization:a meta-analysis of observational studies[J].Atherosclerosis,2014,234(1):206-213.DOI: 10.1016/j.atherosclerosis.2014.03.003.
[5]	Balta S,Ozturk C.The platelet-lymphocyte ratio:a simple,inexpensive and rapid prognostic marker for cardiovascular events[J].Platelets,2015,26(7):680-681.DOI: 10.3109/09537104.2014.979340.
[6]	Lu XX,Wang SX,Zhang GZ,et al.High neutrophil-to-lymphocyte ratio is a significant predictor of cardiovascular and all-cause mortality in patients undergoing peritoneal dialysis[J].Kidney Blood Press Res,2018,43(2):490-499.DOI: 10.1159/000488696.
[7]	Chen TL,Yang M.Platelet-to-lymphocyte ratio is associated with cardiovascular disease in continuous ambulatory peritoneal dialysis patients[J].Int Immunopharmacol,2020,78:106063.DOI: 10.1016/j.intimp.2019.106063.
[8]	国家肾脏疾病临床医学研究中心.中国慢性肾脏病矿物质和骨异常诊治指南概要[J].肾脏病与透析肾移植杂志,2019,28(1):52-57.DOI: 10.3969/j.issn.1006-298X.2019.01.012. National Clinical Research Center of Kidney Diseases.Summary of China 2018 chronic kidney disease-mineral and bone disorder guideline[J].Chin J Nephrol Dial Transplant,2019,28(1):52-57.DOI: 10.3969/j.issn.1006-298X.2019.01.012.
[9]	张丽娜,邢昌赢,沈冲,等.术中及围手术期血清iPTH监测对501例继发性甲状旁腺功能亢进患者手术效果的精准诊断研究[J].中国血液净化,2017,16(4):227-233.DOI: 10.3969/j.issn.1671-4091.2017.04.004. Zhang LN,Xing CY,Shen C,et al.Diagnostic accuracy study of intraoperative and perioperative serum intact ipth level for successful parathyroidectomy in 501 secondary hyperparathyroidism patients[J].Chin T Blood Purif,2017,16(4):227-233.DOI: 10.3969/j.issn.1671-4091.2017.04.004.
[10]	Yang PS,Liu CL,Liu TP,et al.Parathyroidectomy decreases neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios[J].J Surg Res,2018,224:169-175.DOI: 10.1016/j.jss.2017.12.016.
[11]	Munoz Mendoza J,Isakova T,Cai X,et al.Inflammation and elevated levels of fibroblast growth factor 23 are independent risk factors for death in chronic kidney disease[J].Kidney Int,2017,91(3):711-719.DOI: 10.1016/j.kint.2016.10.021.
[12]	Yaprak M,Turan MN,Dayanan R,et al.Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients[J].Int Urol Nephrol,2016,48(8):1343-1348.DOI: 10.1007/s11255-016-1301-4.
[13]	Tzanno-Martins C,Futata E,Jorgetti V,et al.Restoration of impaired T-cell proliferation after parathyroidectomy in hemodialysis patients[J].Nephron,2000,84(3):224-227.DOI: 10.1159/000045581.
[14]	Saddadi F,Alatab S,Pasha F,et al.The effect of treatment with N-acetylcysteine on the serum levels of C-reactive protein and interleukin-6 in patients on hemodialysis[J].Saudi J Kidney Dis Transpl,2014,25(1):66.DOI: 10.4103/1319-2442.124489.
[15]	Soehnlein O.Multiple roles for neutrophils in atherosclerosis[J].Circ Res,2012,110(6):875-888.DOI: 10.1161/circresaha.111.257535.
[16]	Nunez J,Minana G,Bodi V,et al.Low lymphocyte count and cardiovascular diseases[J].Curr Med Chem,2011,18(21):3226-3233.DOI: 10.2174/092986711796391633.
[17]	Babitt JL,Lin HY.Mechanisms of anemia in CKD[J].J Am Soc Nephrol,2012,23(10):1631-1634.DOI: 10.1681/asn.2011111078.
[18]	Drueke TB.Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients[J].Nephrol Dial Transplant,2002,17(90005):28-31.DOI: 10.1093/ndt/17.suppl_5.28.
[19]	Valga F,Monzón T,Henriquez F,et al.Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios as markers of erythropoietin resistance in chronic haemodialysis patients:a multicentre cross-sectional study[J].Nefrología Engl Ed,2020,40(3):320-327.DOI: 10.1016/j.nefroe.2020.06.010.
[20]	沈英,张萍,蒋华,等.甲状旁腺切除对尿毒症继发甲状旁腺功能亢进患者贫血和心功能的影响[J].中华肾脏病杂志,2018,34(5):321-326.DOI: 10.3760/cma.j.issn.1001-7097.2018.05.001. Shen Y,Zhang P,Jiang H,et al.Effect of parathyroidectomy onAnemia and cardiac function in uremic patients with secondary hyperparathyroidism[J].Chin J Nephrol,2018,34(5):321-326.DOI: 10.3760/cma.j.issn.1001-7097.2018.05.001.
[21]	Brancaccio D,Cozzolino M,Gallieni M.Hyperparathyroidism and Anemia in uremic subjects:a combined therapeutic approach[J].J Am Soc Nephrol,2004,15 Suppl 1:S21-S24.DOI: 10.1097/01.asn.0000093369.09194.12.
[22]	Taymez DG,Ucar E,Turkmen K,et al.The predictive value of platelet/lymphocyte ratio in hemodialysis patients with erythropoietin resistance[J].Ther Apher Dial,2016,20(2):118-121.DOI: 10.1111/1744-9987.12380.