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中华肾病研究电子杂志 ›› 2025, Vol. 14 ›› Issue (01) : 7 -12. doi: 10.3877/cma.j.issn.2095-3216.2025.01.002

论著

中性粒细胞与淋巴细胞比值对腹膜透析糖尿病患者心血管疾病死亡风险的预测作用
王欢1, 王洪峰2, 金重珍1, 彭小芬3, 金艳华1, 张德伟1, 张艳宁1,()   
  1. 1. 110016 沈阳,北部战区总医院肾脏病科
    2. 100853 北京,解放军总医院第一医学中心肾脏病医学部、肾脏疾病全国重点实验室、国家慢性肾病临床医学研究中心、重症肾脏疾病器械与中西医药物研发北京市重点实验室、数智中医泛血管疾病防治北京市重点实验室、国家中医药管理局高水平中医药重点学科
    3. 530000 南宁,解放军联勤保障部队第923 医院健康医学科
  • 收稿日期:2024-04-21 出版日期:2025-02-28
  • 通信作者: 张艳宁
  • 基金资助:
    辽宁省应用基础研究计划(2023JH2/101300078,2022JH2/101500043)

Predictive role of neutrophil to lymphocyte ratio in cardiovascular disease mortality risk of peritoneal dialysis patients with diabetes mellitus

Huan Wang1, Hongfeng Wang2, Zhongzhen Jin1, Xiaofen Peng3, Yanhua Jin1, Dewei Zhang1, Yanning Zhang1,()   

  1. 1. Department of Nephrology, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province
    2. Department of Nephrology, First Medical Center of Chinese PLA General Hospital, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Medical Devices and Integrated Traditional Chinese and Western Drug Development for Severe Kidney Diseases, Beijing Key Laboratory of Digital Intelligent TCM for Prevention and Treatment of Panvascular Diseases, Key Disciplines of National Administration of Traditional Chinese Medicine (zyyzdxk-2023310),Beijing 100853
    3. Department of Health Medicine, 923rd Hospital of Chinese PLA Joint Logistic Support Force,Nanning 530000, Guangxi Zhuang Autonomous Region; China
  • Received:2024-04-21 Published:2025-02-28
  • Corresponding author: Yanning Zhang
引用本文:

王欢, 王洪峰, 金重珍, 彭小芬, 金艳华, 张德伟, 张艳宁. 中性粒细胞与淋巴细胞比值对腹膜透析糖尿病患者心血管疾病死亡风险的预测作用[J/OL]. 中华肾病研究电子杂志, 2025, 14(01): 7-12.

Huan Wang, Hongfeng Wang, Zhongzhen Jin, Xiaofen Peng, Yanhua Jin, Dewei Zhang, Yanning Zhang. Predictive role of neutrophil to lymphocyte ratio in cardiovascular disease mortality risk of peritoneal dialysis patients with diabetes mellitus[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2025, 14(01): 7-12.

目的

探讨中性粒细胞与淋巴细胞比值(NLR)对腹膜透析(PD)糖尿病(DM)患者心血管疾病(CVD)死亡风险的预测作用。

方法

回顾性分析2013 年1 月至2021 年9 月在北部战区总医院行PD 置管术的DM 患者临床资料。 利用受试者工作特征(ROC)曲线确定NLR 的最佳截断值,从而将研究对象分为低NLR 和高NLR 组。 采用Kaplan-Meier 法进行生存分析,多因素Cox 回归比例风险模型分析影响患者CVD 死亡的危险因素。

结果

共纳入行PD 的DM 患者201 例,ROC 曲线显示NLR 预测CVD 死亡的最佳截断值是3.36,因此根据该值将研究对象分为低NLR 组52 例和高NLR组149 例。 与低NLR 组相比较,高NLR 组中性粒细胞水平较高,身体质量指数(BMI)和淋巴细胞水平较低。 Kaplan-Meier 曲线分析显示,高NLR 组患者的总生存率低于低NLR 组(16.70%比71.90%,χ2 =5.765,P=0.016)。 校正混杂因素后,多因素Cox 回归模型分析结果显示,NLR(HR=1. 082,95%CI:1.013~1.155,P=0.019)是行PD 的DM 患者CVD 死亡独立危险因素,而BMI(HR=0.847,95%CI:0.770~0.933,P=0.001)是保护因素。

结论

NLR 是行PD 的DM 患者CVD 死亡的独立危险因素,对临床工作具有一定的参考价值。

Objective

To explore the predictive role of neutrophil to lymphocyte ratio (NLR) in cardiovascular disease (CVD) morality risk of peritoneal dialysis (PD) patients with diabetes mellitus(DM).

Methods

A retrospective analysis of clinical data of DM patients who underwent PD catheterization at the General Hospital of Northern Theater Command from January 2013 to September 2021 was conducted.By using receiver operating characteristic (ROC) curves to determine the optimal cutoff value for NLR, the study subjects were divided into low NLR and high NLR groups.Kaplan-Meier method was used for survival analysis, and a multivariate Cox regression proportional hazards model was used to analyze the risk factors affecting CVD mortality of the patients.

Results

A total of 201 PD patients with DM were included.The ROC curve showed that the optimal cut-off value of NLR for predicting CVD morality was 3.36.Therefore,the subjects were divided into a low NLR group (n=52) and a high NLR group (n=149).Compared with the low NLR group, the high NLR group had higher level of neutrophils but lower levels of body mass index(BMI) and lymphocytes.Kaplan-Meier curve analysis showed that the overall survival rate of patients in the high NLR group was lower than that in the low NLR group (16.70% vs. 71.90%χ2=5.765, P=0.016).After adjusting for confounding factors, the results of the multivariate Cox regression model analysis showed that NLR (HR= 1. 082, 95%CI: 1. 013-1. 155, P= 0.019) was an independent risk factor for CVD mortality risk in the DM patients undergoing PD, while BMI (HR=0. 847, 95%CI: 0. 770-0. 933, P=0.001) was a protective factor.

Conclusion

NLR was an independent risk factor for CVD mortality risk in the DM patients undergoing PD, which may have certain reference value for clinical work.

图1 预测腹膜透析合并糖尿病患者心血管疾病死亡的受试者工作特征曲线 注:NLR:中性粒细胞与淋巴细胞比值
表1 两组腹膜透析合并糖尿病患者的临床资料
变量 低NLR 组(52 例) 高NLR 组(149 例) 统计量 P
性别(女性)[例(%)] 36(56. 30) 59(42. 40) χ 2 =3. 354 0. 067
年龄(岁) 58. 00±11. 85 59. 72±11. 73 t=-0. 907 0. 365
身体质量指数(kg/ m2 25. 95(24. 32,28. 29) 24. 41(22. 32,26. 54) Z =-3. 499 <0. 001
高血压病史[例(%)] 64(100. 00) 135(97. 10) χ 2 =1. 879 0. 170
吸烟史[例(%)] 22(34. 40) 52(37. 40) χ 2 =0. 174 0. 676
心力衰竭病史[例(%)] 13(25. 00) 27(18. 10) χ 2 =1. 144 0. 315
心律失常病史[例(%)] 6(11. 50) 23(15. 40) χ 2 =0. 474 0. 510
冠状动脉疾病病史[例(%)] 15(28. 80) 50(33. 60) χ 2 =0. 391 0. 607
脑血管病病史[例(%)] 5(9. 60) 17(11. 40) χ 2 =0. 127 0. 803
血清肌酐(μmol/ L) 721. 00(583. 50,897. 65) 756. 50(560. 75,896. 50) Z =-0. 256 0. 798
血尿酸(μmol/ L) 0. 45±0. 13 0. 46±0. 13 t=-0. 571 0. 569
同型半胱氨酸(μmol/ L) 21. 60(16. 41,32. 32) 25. 13(18. 11,33. 57) Z =-1. 353 0. 176
血糖(mmol/ L) 7. 00(4. 97,9. 51) 7. 30(5. 55,9. 82) Z =-1. 177 0. 239
总胆固醇(mmol/ L) 5. 10(3. 92,7. 14) 4. 97(3. 77,5. 94) Z =-1. 073 0. 283
甘油三酯(mmol/ L) 1. 60(1. 20,3. 27) 1. 77(1. 30,2. 53) Z =-0. 363 0. 717
D-二聚体(mg/ L) 0. 98(0. 61,1. 69) 1. 13(0. 69,2. 07) Z =-1. 925 0. 054
纤维蛋白原(g/ L) 5. 13(4. 45,5. 90) 5. 27(4. 42,6. 40) Z =-1. 109 0. 267
二氧化碳结合力(mmol/ L) 21. 87±4. 46 2135±5. 31 t=0. 629 0. 532
血钙(mmol/ L) 2. 03(1. 90,2. 15) 1. 99(1. 86,2. 14) Z =-0. 839 0. 401
血磷(mmol/ L) 1. 79(1. 54,2. 09) 1. 79(1. 53,2. 17) Z =-0. 425 0. 671
血清白蛋白(g/ L) 32. 00(28. 95,35. 95) 33. 05(28. 70,36. 48) t=1. 389 0. 166
血小板计数(×109 / L) 204. 00(160. 50,252. 50) 209. 50(163. 25,273. 75) Z =-0. 564 0. 573
血红蛋白(g/ L) 82. 00(72. 00,99. 50) 84. 00(74. 00,96. 00) Z =-0. 283 0. 778
中性粒细胞计数(×109 / L) 3. 50(2. 60,4. 41) 5. 60(4. 40,7. 40) Z =-6. 450 <0. 001
淋巴细胞计数(×109 / L) 1. 45(1. 10,1. 70) 0. 99(0. 70,1. 28) Z =-7. 025 <0. 001
图2 两组腹膜透析合并糖尿病患者的总生存率比较 注:NLR:中性粒细胞与淋巴细胞比值
表2 影响腹膜透析合并糖尿病患者心血管疾病死亡的单因素及多因素Cox 回归模型分析
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