切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 64 -69. doi: 10.3877/cma.j.issn.2095-3216.2021.02.002

所属专题: 文献

论著

中性粒细胞/淋巴细胞比值对急性肾损伤重症患者预后的评估价值
陈蕾1, 魏丽敏1, 程鑫2, 郭小霞3,(), 蒋红利1,()   
  1. 1. 710061 西安交通大学第一附属医院血液净化科
    2. 710089 西安交通大学第一附属医院东院肾脏内科
    3. 710004 西安市第四医院
  • 收稿日期:2020-07-11 出版日期:2021-04-30
  • 通信作者: 郭小霞, 蒋红利
  • 基金资助:
    国家自然科学基金(81870507)

Value of neutrophil-to-lymphocyte ratio in evaluating prognosis of patients with severe acute kidney injury

Lei Chen1, Limin Wei1, Xin Cheng2, Xiaoxia Guo3,(), Hongli Jiang1,()   

  1. 1. Department of Blood Purification, First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061
    2. Department of Nephrology, Eastern Hospital of First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710089
    3. Xi′an City Fourth Hospital, Xi′an 710004; Shaanxi Province, China
  • Received:2020-07-11 Published:2021-04-30
  • Corresponding author: Xiaoxia Guo, Hongli Jiang
引用本文:

陈蕾, 魏丽敏, 程鑫, 郭小霞, 蒋红利. 中性粒细胞/淋巴细胞比值对急性肾损伤重症患者预后的评估价值[J/OL]. 中华肾病研究电子杂志, 2021, 10(02): 64-69.

Lei Chen, Limin Wei, Xin Cheng, Xiaoxia Guo, Hongli Jiang. Value of neutrophil-to-lymphocyte ratio in evaluating prognosis of patients with severe acute kidney injury[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(02): 64-69.

目的

探讨中性粒细胞/淋巴细胞比值(NLR)与急性肾损伤(AKI)重症患者90 d死亡风险之间的关系,评估NLR对此类患者预后的预测价值。

方法

回顾性分析2015年1月至2019年12月收治于西安交通大学第一附属医院重症监护病房的802例AKI患者,根据入院初始NLR水平分为低NLR组(NLR<9)及高NLR组(NLR≥9),比较组间基础疾病、初始序贯器官衰竭评分(SOFA)、白细胞(WBC)、中性粒细胞百分比(NEU%)、血红蛋白(Hb)、血小板(PLT)、乳酸(Lac)、pH值、血糖(Glu)、肌酸激酶(CK)、90 d全因死亡情况等变量之间的差异。运用Logistic回归模型分析AKI重症患者90 d死亡的危险因素;绘制受试者工作特征(ROC)曲线,并根据ROC曲线下面积(AUC)评估NLR对AKI重症患者住院90 d死亡风险的预测价值。

结果

两组患者的年龄、性别、AKI分期、Glu差异均无统计学意义;高NLR组患者的SOFA评分、WBC、Neu%、Hb、PLT、BUN、SCr、Lac及CK均高于低NLR组患者,BMI及pH值低于低NLR组患者。相较于低NLR组,高NLR组的90 d死亡率明显升高(32.6% vs 16%,P<0.001)。多因素Logistic回归分析显示,即使校正了年龄、性别、BMI、基础病因素、Lac值、AKI分期以及SOFA评分后,NLR仍是AKI重症患者90 d死亡的独立预测因子(OR=2.402,95%CI:1.633~3.533,P<0.001)。基于传统指标(年龄、性别、BMI、基础疾病、AKI分期、SOFA评分及Lac)的90 d死亡风险基础预测模型AUC为0.761(95%CI:0.730~0.790),而基础模型联合NLR的90 d死亡风险预测模型AUC为0.783(95%CI:0.753~0.811),二者之间的差异具有统计学意义(P=0.0067)。

结论

NLR对AKI重症患者90 d死亡风险具有一定的预测价值,有助于提高基础模型对AKI重症患者90 d死亡风险的预测能力。

Objective

To explore the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the 90-day mortality risk in severe patients with acute kidney injury (AKI), so as to evaluate the predictive value of NLR for the prognosis.

Methods

Retrospective analysis was made in 802 AKI patients who were admitted to the intensive care unit of the First Affiliated Hospital of Xi′an Jiaotong University from January 2015 to December 2019, and divided into low-NLR group (NLR<9) and high-NLR group (NLR≥9) according to the NLR level at admission. Differences were compared between the two groups in the underlying diseases, initial sequential organ failure assessment (SOFA), white blood cells (WBC), neutrophil percentage (NEU%), hemoglobin (Hb), platelet (PLT), lactic acid (Lac), pH, blood glucose (Glu), creatine kinase (CK), 90-day all-cause-death, and other variables. Logistic regression model was used to analyze the risk factors for 90-day mortality in critically ill patients with AKI. The receiver operating characteristic (ROC) curve was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of NLR for the 90-day mortality in critically ill patients with AKI.

Results

There was no statistically significant difference in age, gender, ill AKI staging, and Glu between the two groups. In the high-NLR group, the levels of SOFA score, WBC, Neu%, Hb, PLT, BUN, SCr, Lac, and CK were higher, while BMI and pH were lower than those in the low-NLR group. The 90-day mortality rate was significantly higher in the high-NLR group than in the low-NLR group (32.6% vs 16%, P< 0.001). Multivariate logistic regression analysis showed that even after adjustment for age, gender, BMI, underlying disease factors, Lac value, AKI staging, and SOFA score, the NLR was still an independent predictor of 90-day mortality in critically ill patients with AKI (OR=2.402, 95%CI: 1.633-3.533, P<0.001). The AUC of the 90-day mortality risk prediction model based on traditional indicators (age, gender, BMI, underlying diseases, AKI staging, SOFA score, and Lac) was 0.761 (95%CI: 0.730-0.790), while the AUC of the 90-day mortality risk prediction model based on both traditional indicators and NLR was 0.783 (95%CI: 0.753 to 0.811), and the difference between the two models was statistically significant (P=0.0067).

Conclusion

NLR had a certain predictive value for the 90-day mortality risk in critically ill AKI patients, and might help improve the predictive ability of the model based on the traditional indicators.

表1 两组患者的一般资料
表2 两组患者的实验室检查结果
表3 影响AKI重症患者90 d死亡的单因素Logistic回归分析
表4 影响AKI重症患者90 d死亡的多因素Logistic回归分析
图1 急性肾损伤重症患者90 d死亡的2种临床预测模型(基础模型及基础模型联合NLR)的ROC曲线
[1]
Sawhney S, Marks A, Fluck N, et al. Intermediate and long-term outcomes of survivors of acute kidney injury episodes: a large population-based cohort study [J]. Am J Kidney Dis, 2017, 69(1): 18-28.
[2]
Kaddourah A, Basu RK, Bagshaw SM, et al. Epidemiology of acute kidney injury in critically ill children and young adults [J]. N Engl J Med, 2017, 376(1): 11-20.
[3]
Hoste EAJ, Kellum JA, Selby NM, et al. Global epidemiology and outcomes of acute kidney injury [J]. Nat Rev Nephrol, 2018, 14(10): 607-625.
[4]
Wang HE, Muntner P, Chertow GM, et al. Acute kidney injury and mortality in hospitalized patients [J]. Am J Nephrol, 2012, 35(4): 349-355.
[5]
Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: a systematic review and meta-analysis [J]. Clin Biochem, 2018, 52: 131-136.
[6]
Bonaventura A, Liberale L, Carbone F, et al. Baseline neutrophil-to-lymphocyte ratio is associated with long-term T2D remission after metabolic surgery [J]. Acta Diabetol, 2019, 56(7): 741-748.
[7]
Mei Z, Shi L, Wang B, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies [J]. Cancer Treat Rev, 2017, 58: 1-13.
[8]
Rabb H, Griffin MD, Mckay DB, et al. Inflammation in AKI: current understanding, key questions, and knowledge gaps [J]. J Am Soc Nephrol, 2016, 27(2): 371-379.
[9]
Bu X, Zhang L, Chen P, et al. Relation of neutrophil-to-lymphocyte ratio to acute kidney injury in patients with sepsis and septic shock: a retrospective study [J]. Int Immunopharmacol, 2019, 70: 372-377.
[10]
陈巧芹. 过敏性紫癜患儿急性肾损伤与中性粒细胞和淋巴细胞比值的相关性[J]. 儿科药学杂志,2019, 25(6): 3-6.
[11]
王利华,苏晓乐. 急性肾损伤的诊断和早期预警[J/CD]. 中华肾病研究电子杂志,2019, 8(4): 145-149.
[12]
Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults [J]. Clin J Am Soc Nephrol, 2015, 10(9): 1510-1518.
[13]
肖力,孙林,刘伏友. 急性肾脏病的病因及发病机制[J/CD]. 中华肾病研究电子杂志,2017, 6(6): 252-258.
[14]
Chen D, Xiao D, Guo J, et al. Neutrophil-lymphocyte count ratio as a diagnostic marker for acute kidney injury: a systematic review and meta-analysis [J]. Clin Exp Nephrol, 2020, 24(2): 126-135.
[15]
Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19 [J]. J Infect, 2020, 81(1): e6-e12.
[16]
韩蕊,丛燕,赵澐. 中性粒细胞/淋巴细胞比值在老年脓毒症患者急性肾损伤诊断和预后中的价值[J]. 老年医学与保健,2020, 26(2): 262-265, 273.
[17]
Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer [J]. Crit Rev Oncol Hematol, 2013, 88(1): 218-230.
[18]
Kantola T, Klintrup K, Väyrynen JP, et al. Stage-dependent alterations of the serum cytokine pattern in colorectal carcinoma [J]. Br J Cancer, 2012, 107(10): 1729-1736.
[1] 张婧琦, 江洋, 孙佳璐, 唐兴喆, 赵宇飞, 崔颖, 李信响, 戴景月, 傅琳, 彭新桂. 基于肾周CT特征结合血清肌酐水平探讨脓毒症伴急性肾损伤的早期识别[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 285-292.
[2] 樊恒, 孙敏, 朱建华. 红景天苷通过抑制PI3K/AKT/mTOR信号通路对大鼠脓毒症急性肾损伤的保护作用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 188-195.
[3] 张锦丽, 席毛毛, 褚志刚, 栾夏刚, 陈诺, 王德运, 谢卫国. 大面积烧伤患者发生早期急性肾损伤的危险因素分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 282-287.
[4] 彭瑞, 杨瑞文, 魏澹宁, 夏永良. 琥珀酸受体1加重肾脏缺血再灌注损伤的作用研究[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 159-164.
[5] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国肝移植受者肾损伤管理临床实践指南(2023版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 276-288.
[6] 杜霞, 马梦青, 曹长春. 造影剂诱导的急性肾损伤的发病机制及干预靶点研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 279-282.
[7] 郭俊楠, 林惠, 任艺林, 乔晞. 氨基酸代谢异常在急性肾损伤向慢性肾脏病转变中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 283-287.
[8] 袁楠, 黄梦杰, 白云凤, 李晓帆, 罗从娟, 陈健文. 急性肾损伤-慢性肾脏病转化小鼠模型制备的教学要点及学习效果分析[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 226-230.
[9] 林玲, 李京儒, 沈瑞华, 林惠, 乔晞. 基于生物信息学分析小鼠急性肾损伤和急性肺损伤的枢纽基因[J/OL]. 中华肾病研究电子杂志, 2024, 13(03): 134-144.
[10] 周建芳, 罗旭颖, 张琳琳, 李宏亮, 杨燕琳, 陈光强, 石广志. 开颅术后危重患者急性肾损伤的发病率、危险因素及其对预后的影响[J/OL]. 中华重症医学电子杂志, 2024, 10(02): 148-156.
[11] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[12] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[13] 崔秋子, 姚红曼, 艾迎春. 监测NLR、PLR、CAR、白蛋白、血钙及血糖指标水平对急性胰腺炎患者急性肾损伤的预测价值分析[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 244-248.
[14] 高静, 夏婷婷. 血清乳酸脱氢酶、中性粒细胞/淋巴细胞比值、血浆纤维蛋白原/前白蛋白比值对晚期结直肠癌患者姑息化疗效果与不良反应的评价[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(03): 203-207.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要