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中性粒细胞与淋巴细胞比值(NLR)已经成为近年来备受关注的新的炎症指标,已被证实对部分疾病包括冠心病、自身免疫性疾病和慢性肾病(CKD)等[1-2]有诊断预测和预后判断等作用,在2型糖尿病(T2DM)及并发症中也有研究[3]。糖尿病肾病(DN)是T2DM常见严重慢性并发症之一,白蛋白尿不仅是其筛查和诊断最为常用的指标,还是肾脏损伤的重要标志、糖尿病病人死亡及全因死亡的独立危险因素[4-5]。NLR与T2DM的DN相关性少有研究,与白蛋白尿分组研究更少,故本研究旨在探讨并发不同程度白蛋白尿的T2DM病人NLR的变化及相关性,现作报道。
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MAU组病人的年龄、病程、FBG、HbA1c、TC、TG、LDL-C、hs-CRP、Cys-C及NLR均高于NAU组(P < 0.05~P < 0.01),HDL-C低于NAU组(P < 0.05);CAU组病人年龄、病程、SBP、FBG、HbA1c、TC、TG、LDL-C、Cr、UA、hs-CRP、Cys-C及NLR均高于NAU组(P < 0.05~P < 0.01),病程、FBG、HbA1c、Cr、UA、hs-CRP及NLR也均高于MAU组(P < 0.01),HDL-C低于NAU组(P < 0.01)。各组间病人的性别、DBP、BMI差异均无统计学意义(P>0.05)(见表 1)。
指标 NAU组(n=97) MAU组(n=91) CAU组(n=111) F P MS组内 性别比(男/女) 55/42 53/38 67/44 0.29# > 0.05 — 年龄/岁 50.00±5.51 57.56±7.17** 58.91±8.10** 46.21 < 0.01 49.860 病程/年 7.44±2.25 9.55±3.67** 11.49±5.05**△△ 27.91 < 0.01 15.214 SBP/mmHg 128.07±15.87 131.73±15.23 134.87±14.17** 5.28 < 0.01 226.827 DBP/mmHg 76.44±12.75 77.90±12.68 78.96±12.50 1.03 > 0.05 159.675 BMI/(kg/m2) 24.31±2.22 24.58±2.41 24.79±2.53 1.04 > 0.05 5.743 FBG/(mmol/L) 7.68±1.05 9.34±1.71** 10.23±1.78**△△ 70.60 < 0.01 2.424 HbA1c/% 7.54±0.81 8.28±0.94** 8.80±1.06**△△ 45.87 < 0.01 0.890 TC/(mmol/L) 4.97±0.83 5.30±0.90* 5.50±0.88** 9.69 < 0.01 0.758 TG/(mmol/L) 1.81±0.66 2.08±0.73* 2.04±0.69* 4.28 < 0.05 0.480 HDL-C/(mmol/L) 1.36±0.20 1.26±0.20** 1.22±0.19** 13.68 < 0.01 0.039 LDL-C/(mmol/L) 3.02±0.57 3.25±0.67* 3.34±0.62** 7.18 < 0.01 0.385 Cr/(mmol/L) 61.64±11.38 62.37±11.29 74.62±13.01**△△ 38.82 < 0.01 143.658 UA/(μmol/L) 313.41±63.11 316.93±68.80 420.42±73.69**△△ 81.55 < 0.01 4 748.950 hs-CRP/(mg/L) 3.88±0.64 4.54±0.96** 5.42±1.91**△△ 35.17 < 0.01 1.769 Cys-C/(mg/L) 0.99±0.30 1.09±0.36* 1.13±0.34** 4.73 < 0.01 0.112 NLR 1.54±0.26 2.24±0.55** 2.78±0.71**△△ 132.26 < 0.01 0.301 q检验:与NAU组比较* P < 0.05, ** P < 0.01;与MAU组比较△△ P < 0.01;#示χ2值 表 1 一般资料及实验室指标在各组的比较(x±s)
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以有无白蛋白尿为因变量,以病程、SBP、DBP、BMI、FBG、HbA1c、TC、TG、HDL-C、LDL-C、Cr、UA、hs-CRP、Cys-C、NLR为自变量进行多元logistic回归分析,结果显示, 病程、SBP、DBP、FBG、TG、LDL-C、Cr、hs-CRP、Cys-C及NLR是影响DN的相关因素(P < 0.05~P < 0.01);在众多因素中,NLR是影响T2DM白蛋白尿的最重要因素(OR值最大)(见表 2)。
变量 B SE Wald χ2 P OR(95% CI) 截距 -53.34 9.77 29.81 < 0.01 — 病程 0.34 0.10 12.90 < 0.01 1.27(1.10~1.47) SBP 0.16 0.05 10.73 < 0.01 1.17(1.07~1.29) DBP -0.14 0.06 6.53 < 0.05 0.87(0.78~0.97) FBG 1.64 0.48 11.61 < 0.01 5.16(2.01~13.24) TG -2.82 0.84 11.12 < 0.01 0.06(0.01~0.31) LDL-C 3.08 0.94 10.82 < 0.01 21.76(3.47~136.37) Cr 0.09 0.03 8.39 < 0.01 1.10(1.03~1.16) hs-CRP 0.97 0.40 5.74 < 0.05 2.63(1.19~5.80) Cys-C 2.17 1.06 4.17 < 0.05 8.72(1.09~69.75) NLR 6.53 0.96 46.80 < 0.01 685.49(105.56~4451.34) 表 2 T2DM白蛋白尿相关因素的多元logstic回归分析
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NLR与T2DM病人年龄、病程、SBP、DBP、BMI、FBG、HbA1c、TC、TG、HDL-C、LDL-C、Cr、UA、hs-CRP、Cys-C的Pearson相关性分析显示,结果有统计学意义的指标为年龄、病程、FBG、HbA1c、TC、HDL-C、Cr、hs-CRP(P < 0.05~P < 0.01)(见表 3)。
指标 年龄 病程 FBG HbA1c TC HDL-C Cr hs-CRP r 0.133 0.204 0.287 0.245 0.151 -0.252 0.245 0.374 P < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 表 3 NLR与其他指标相关性分析(r)
中性粒细胞与淋巴细胞比值与2型糖尿病不同程度白蛋白尿的相关性分析
Correlation analysis between the ratio of neutrophils to lymphocytes and different levels of albumin in type 2 diabetes mellitus
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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(T2DM)病人不同程度白蛋白尿的相关性。 方法收集T2DM病人299例,按照白蛋白尿程度分为白蛋白尿正常组(NAU组)97例,微量白蛋白尿组(MAU组)91例及临床蛋白尿组(CAU组)111例。分析各组临床资料、NLR及实验室指标特征。 结果MAU组病人年龄、病程、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、超酶C-反应蛋白(hs-CRP)、胱抑素C(Cys-C)及NLR均高于NAU组(P < 0.05~P < 0.01),高密度脂蛋白胆固醇(HDL-C)低于NAU组(P < 0.05);CAU组病人年龄、病程、收缩压、FBG、HbA1c、TC、TG、LDL-C、血肌酐(Cr)、尿酸(UA)、hs-CRP、Cys-C及NLR均高于NAU组(P < 0.05~P < 0.01),病程、FBG、HbA1c、Cr、UA、hs-CRP及NLR也均高于MAU组(P < 0.01),HDL-C低于NAU组(P < 0.01)。多元logisitic回归分析显示,病程、收缩压、舒张压、FBG、TG、LDL-C、Cr、hs-CRP、Cys-C及NLR是影响T2DM白蛋白尿的相关因素(P < 0.05~P < 0.01)。NLR与年龄、病程、FBG、HbA1C、TC、HDL-C、Cr、hs-CRP因素有统计学关联(P < 0.05~P < 0.01)。 结论NLR与2型糖尿病白蛋白尿的发生相关。 -
关键词:
- 糖尿病 /
- 中性粒细胞与淋巴细胞比值 /
- 白蛋白尿
Abstract:ObjectiveTo investigate the correlation between the neutrophil-to-lymphocyte ratio(NLR)and different levels of albumin in type 2 diabetes mellitus(T2DM). MethodsTwo hundred ninety-nine patients with T2DM were divided into the NAU group(n=97), MAU group(n=91)and CAU group(n=111)according to the levels of albumin.The clinical data, NLR and biochemical characteristics in three groups were analyzed. ResultsThe age, course of disease, and levels of FBG, HbA1c, TC, TG, LDL-C, hs-CRP, Cys-C and NL in MAU group were higher than those in NAU group(P < 0.05 to P < 0.01), but the level of HDL-C in MAU group was lower than that in NAU group(P < 0.05).The age, course of disease, and levels of SBP, FBG, HbA1c, TC, TG, LDL-C, Cr, UA, hs-CRP, Cys-C and NLR in CAU group were higher than those in NAU group(P < 0.05 to P < 0.01), the course of disease, FBG, HbA1c, Cr, UA, hs-CRP and NLR in CAU group were higher than those in MAU group(P < 0.05), and the level of HDL-C in MAU group was lower than that in NAU group(P < 0.05).The results of multivariate logistic regression showed that the course of disease, and levels of SBP, DBP, FBG, TG, LDL-C, Cr, hs-CRP, Cys-C and NLR were the relevant factors of influencing the albuninuria in T2DM.The age, duration, and levels of FBG, HbA1C, TC, HDL-C, Cr and hs-CRP were correlation with NLR(P < 0.05 to P < 0.01). ConclusionsThe NLR is associate with the severity of albuninuria in T2DM. -
Key words:
- diabetes mellitus /
- neutrophil-to-lymphocyte ratio /
- albuninuria
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表 1 一般资料及实验室指标在各组的比较(x±s)
指标 NAU组(n=97) MAU组(n=91) CAU组(n=111) F P MS组内 性别比(男/女) 55/42 53/38 67/44 0.29# > 0.05 — 年龄/岁 50.00±5.51 57.56±7.17** 58.91±8.10** 46.21 < 0.01 49.860 病程/年 7.44±2.25 9.55±3.67** 11.49±5.05**△△ 27.91 < 0.01 15.214 SBP/mmHg 128.07±15.87 131.73±15.23 134.87±14.17** 5.28 < 0.01 226.827 DBP/mmHg 76.44±12.75 77.90±12.68 78.96±12.50 1.03 > 0.05 159.675 BMI/(kg/m2) 24.31±2.22 24.58±2.41 24.79±2.53 1.04 > 0.05 5.743 FBG/(mmol/L) 7.68±1.05 9.34±1.71** 10.23±1.78**△△ 70.60 < 0.01 2.424 HbA1c/% 7.54±0.81 8.28±0.94** 8.80±1.06**△△ 45.87 < 0.01 0.890 TC/(mmol/L) 4.97±0.83 5.30±0.90* 5.50±0.88** 9.69 < 0.01 0.758 TG/(mmol/L) 1.81±0.66 2.08±0.73* 2.04±0.69* 4.28 < 0.05 0.480 HDL-C/(mmol/L) 1.36±0.20 1.26±0.20** 1.22±0.19** 13.68 < 0.01 0.039 LDL-C/(mmol/L) 3.02±0.57 3.25±0.67* 3.34±0.62** 7.18 < 0.01 0.385 Cr/(mmol/L) 61.64±11.38 62.37±11.29 74.62±13.01**△△ 38.82 < 0.01 143.658 UA/(μmol/L) 313.41±63.11 316.93±68.80 420.42±73.69**△△ 81.55 < 0.01 4 748.950 hs-CRP/(mg/L) 3.88±0.64 4.54±0.96** 5.42±1.91**△△ 35.17 < 0.01 1.769 Cys-C/(mg/L) 0.99±0.30 1.09±0.36* 1.13±0.34** 4.73 < 0.01 0.112 NLR 1.54±0.26 2.24±0.55** 2.78±0.71**△△ 132.26 < 0.01 0.301 q检验:与NAU组比较* P < 0.05, ** P < 0.01;与MAU组比较△△ P < 0.01;#示χ2值 表 2 T2DM白蛋白尿相关因素的多元logstic回归分析
变量 B SE Wald χ2 P OR(95% CI) 截距 -53.34 9.77 29.81 < 0.01 — 病程 0.34 0.10 12.90 < 0.01 1.27(1.10~1.47) SBP 0.16 0.05 10.73 < 0.01 1.17(1.07~1.29) DBP -0.14 0.06 6.53 < 0.05 0.87(0.78~0.97) FBG 1.64 0.48 11.61 < 0.01 5.16(2.01~13.24) TG -2.82 0.84 11.12 < 0.01 0.06(0.01~0.31) LDL-C 3.08 0.94 10.82 < 0.01 21.76(3.47~136.37) Cr 0.09 0.03 8.39 < 0.01 1.10(1.03~1.16) hs-CRP 0.97 0.40 5.74 < 0.05 2.63(1.19~5.80) Cys-C 2.17 1.06 4.17 < 0.05 8.72(1.09~69.75) NLR 6.53 0.96 46.80 < 0.01 685.49(105.56~4451.34) 表 3 NLR与其他指标相关性分析(r)
指标 年龄 病程 FBG HbA1c TC HDL-C Cr hs-CRP r 0.133 0.204 0.287 0.245 0.151 -0.252 0.245 0.374 P < 0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 -
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