慢性肾脏病3～5期非透析患者中性粒细胞与淋巴细胞比值与腹主动脉钙化的相关性研究
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摘要
目的通过收集慢性肾脏病(CKD)3～5期非透析患者腹主动脉钙化(AAC)资料,分析影响AAC发生的危险因素,探讨中性粒细胞与淋巴细胞比值(NLR)对AAC的预测价值。方法本研究为横断面调查。选取181例CKD3～5期非透析患者,收集相关人口学特征、原发病、用药情况、实验室检查等资料,腹部侧位片检查患者AAC发生情况。根据有无AAC将患者分为钙化组和非钙化组,二分类Logistic回归分析AAC发生的危险因素,ROC曲线探讨NLR对AAC的预测价值。结果 181例CKD3～5期非透析患者中,腹主动脉钙化组63例,非钙化组118例。钙化组NLR水平明显高于非钙化组(P<0.001),二分类Logistic回归分析结果显示年龄(OR=8.898,P=0.008)、超敏C反应蛋白(Hs-CRP)(OR=5.352,P=0.038)、NLR>3.74(OR=33.734,P=0.019)是腹主动脉钙化的危险因素。ROC曲线分析结果显示,NLR与年龄联合指标预测CKD3～5期非透析患者发生AAC时,曲线下面积为0.829(95%CI:0.767～0.890,P<0.001),显著高于NLR(0.780,95%CI:0.706～0.854,P<0.001)和年龄(0.721,95%CI:0.641～0.801,P<0.001)单独分析时的曲线下面积。结论高龄和高水平NLR的CKD3～5期非透析患者发生AAC的风险较高,且NLR和年龄的联合指标对AAC的发生有着较好的预测价值。
Objective To understand the situation of abdominal aortic calcification(AAC) in non-dialysis patients with chronic kidney disease stage 3～5, analyze the risk factors affecting the occurrence of AAC, and explore the predictive value of neutrophil to lymphocyte ratio(NLR) on abdominal aortic calcification. Methods This study was a cross-sectional survey. 181 cases of non-dialysis patients with CKD stage 3～5 were selected to collect relevant demographic characteristics, primary disease, drug use, laboratory examination and other data, and the occurrence of AAC in patients was detected by abdominal lateral radiography. Patients were divided into calcification group and non-calcification group according to the presence or absence of AAC, and risk factors of AAC were analyzed by binary Logistic regression, the ROC curve discussed the predictive value of NLR for AAC. Results Among the 181 cases of non-dialysis patients with CKD 3～5 stage, 63 cases were in the AAC group and 118 cases were in the non-calcification group. The NLR level in the calcification group was significantly higher than that in the non-calcification group[3.8(2.8,5.3) vs 2.5(1.9,3.2),P<0.001]. The results of binary Logistic analysis showed that age(OR=8.898, P=0.008), Hs-CRP(OR=5.352, P=0.038), and NLR>3.74(OR=33.734, P=0.019) were the risk factors for AAC. The ROC curve analysis results showed that when the combined NLR and age predicted the occurrence of AAC in CKD 3～5 non-dialysis patients, the area under the curve was 0.829(95% CI:0.767～0.890, P<0.001), significantly higher than that of NLR(0.780, 95% CI:0.706～0.854, P<0.001) and age(0.721, 95% CI:0.641～0.801, P<0.001). Conclusion CKD 3～5 non-dialysis patients with advanced age and high level of NLR have a higher risk of AAC, and the combined indicators of NLR and age have a better predictive value for the occurrence of AAC.
Objective To understand the situation of abdominal aortic calcification(AAC) in non-dialysis patients with chronic kidney disease stage 3～5, analyze the risk factors affecting the occurrence of AAC, and explore the predictive value of neutrophil to lymphocyte ratio(NLR) on abdominal aortic calcification. Methods This study was a cross-sectional survey. 181 cases of non-dialysis patients with CKD stage 3～5 were selected to collect relevant demographic characteristics, primary disease, drug use, laboratory examination and other data, and the occurrence of AAC in patients was detected by abdominal lateral radiography. Patients were divided into calcification group and non-calcification group according to the presence or absence of AAC, and risk factors of AAC were analyzed by binary Logistic regression, the ROC curve discussed the predictive value of NLR for AAC. Results Among the 181 cases of non-dialysis patients with CKD 3～5 stage, 63 cases were in the AAC group and 118 cases were in the non-calcification group. The NLR level in the calcification group was significantly higher than that in the non-calcification group[3.8(2.8,5.3) vs 2.5(1.9,3.2),P<0.001]. The results of binary Logistic analysis showed that age(OR=8.898, P=0.008), Hs-CRP(OR=5.352, P=0.038), and NLR>3.74(OR=33.734, P=0.019) were the risk factors for AAC. The ROC curve analysis results showed that when the combined NLR and age predicted the occurrence of AAC in CKD 3～5 non-dialysis patients, the area under the curve was 0.829(95% CI:0.767～0.890, P<0.001), significantly higher than that of NLR(0.780, 95% CI:0.706～0.854, P<0.001) and age(0.721, 95% CI:0.641～0.801, P<0.001). Conclusion CKD 3～5 non-dialysis patients with advanced age and high level of NLR have a higher risk of AAC, and the combined indicators of NLR and age have a better predictive value for the occurrence of AAC.
引文
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[10] Dounousi E,Papavasiliou E,Makedou A,et al.Oxidative stress is progressively enhanced with advancing stages of CKD[J].Am J Kidney Dis,2006,48(5):752-60.
[11] 王磊,左力.炎症对慢性肾脏病贫血的影响[J].中国血液净化,2017,16(8):505-8.
[12] Agharazii M,St-Louis R,Gautier-Bastien A,et al.Inflammatory cytokines and reactive oxygen species as mediators of chronic kidney disease-related vascular calcification[J].Am J Hypertens,2015,28(6):746-55.
[13] Kurtul A,Murat S N,Yarlioglues M,et al.Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes[J].Am J Cardiol,2014,114(7):972-8.
[14] 张乐,张存泰.血管钙化和血管老化[J].中华老年医学杂志,2016,35(10):1046-50.
[15] Yamamoto D,Suzuki S,Ishii H,et al.Predictors of abdominal aortic calcification progression in patients with chronic kidney disease without hemodialysis[J].Atherosclerosis,2016,253:15-21.
[16] Chen H,Han X,Cui Y,et al.Parathyroid hormone fragments:new targets for the diagnosis and treatment of chronic kidney disease-mineral and bone disorder[J].Biomed Res Int,2018,2018:9619253.
[2] Bozic M,Mendez-Barbero N,Gutierrez-Munoz C,et al.Combination of biomarkers of vascular calcification and sTWEAK to predict cardiovascular events in chronic kidney disease[J].Atherosclerosis,2018,270:13-20.
[3] Ozcicek A,Ozcicek F,Yildiz G,et al.Neutrophil-to-lymphocyte ratio as a possible indicator of epicardial adipose tissue in patients undergoing hemodialysis[J].Arch Med Sci,2017,13(1):118-23.
[4] Kidney disease:improving global outcomes (KDIGO) CKD-MBD work group.KDIGO clinical practice guideline for the diagnosis,evaluation,prevention,and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)[J].Kidney Int Suppl,2009(113):S1-130.
[5] 蔡宏,严玉澄,陆任华,等.维持性血液透析患者腹主动脉钙化发病情况及与心血管疾病的关系[J].上海交通大学学报(医学版),2012,32(8):1062-7.
[6] Fukagawa M,Yokoyama K,Koiwa F,et al.Clinical practice guideline for the management of chronic kidney disease-mineral and bone disorder[J].Ther Apher Dial,2013,17(3):247-88.
[7] Kauppila L I,Polak J F,Cupples L A,et al.New indices to classify location,severity and progression of calcific lesions in the abdominal aorta:a 25-year follow-up study[J].Atherosclerosis,1997,132(2):245-50.
[8] 王冬梅,王科,方媛,等.慢性肾脏病5期患者血清BMP-2及BMP-7与颈动脉钙化的相关性研究[J].安徽医科大学学报,2016,51(5):762-4.
[9] 张小红,陈财铭,万建新.非透析慢性肾脏病患者骨量异常与血管钙化的危险因素[J].中华肾脏病杂志,2017,33(2):100-5.
[10] Dounousi E,Papavasiliou E,Makedou A,et al.Oxidative stress is progressively enhanced with advancing stages of CKD[J].Am J Kidney Dis,2006,48(5):752-60.
[11] 王磊,左力.炎症对慢性肾脏病贫血的影响[J].中国血液净化,2017,16(8):505-8.
[12] Agharazii M,St-Louis R,Gautier-Bastien A,et al.Inflammatory cytokines and reactive oxygen species as mediators of chronic kidney disease-related vascular calcification[J].Am J Hypertens,2015,28(6):746-55.
[13] Kurtul A,Murat S N,Yarlioglues M,et al.Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes[J].Am J Cardiol,2014,114(7):972-8.
[14] 张乐,张存泰.血管钙化和血管老化[J].中华老年医学杂志,2016,35(10):1046-50.
[15] Yamamoto D,Suzuki S,Ishii H,et al.Predictors of abdominal aortic calcification progression in patients with chronic kidney disease without hemodialysis[J].Atherosclerosis,2016,253:15-21.
[16] Chen H,Han X,Cui Y,et al.Parathyroid hormone fragments:new targets for the diagnosis and treatment of chronic kidney disease-mineral and bone disorder[J].Biomed Res Int,2018,2018:9619253.