2型糖尿病患者外周血血小板/淋巴细胞比值与肾小球滤过率的相关性分析
摘要
目的探讨2型糖尿病患者外周血血小板/淋巴细胞比值(PLR)和估算的肾小球滤过率(eGFR)的相关性。方法选取2016年1月至2017年6月就诊于安徽省第二人民医院内分泌科的128例2型糖尿病患者,根据eGFR水平分为3组,分别为糖尿病0组(DMO组) 69例,糖尿病1组(DM1组) 35例,糖尿病2组(DM2组) 24例。另纳入同期至安徽省第二人民医院的健康体检者30例为对照组(NC组)。检测各组血压、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(Hb A1c)及血常规、血清清蛋白、尿素氮、肌酐、尿酸水平。采用Pearson相关性分析和多元线性回归分析PLR与eGFR的相关性。结果①与NC组和DM0组比较,DM1组、DM2组PLR均升高,eGFR均下降(P均<0. 05);与DM1组比较,DM2组PLR升高,eGFR下降(P均<0. 05); DM0组与NC组比较,PLR、eGFR差异均无统计学意义(P均> 0. 05)。②Pearson相关性分析结果显示,PLR、年龄、病程、收缩压、TC、HDL-C均与eGFR呈负相关(r=-0. 334、-0. 645、-0. 541、-0. 378、-0. 236、-0. 235,P均<0. 05); Hb A1c与eGFR呈正相关(r=0. 211,P <0. 05)。③多元线性回归分析结果显示,PLR和年龄、病程、收缩压是2型糖尿病患者eGFR的影响因素。结论 2型糖尿病患者PLR升高与eGFR下降密切相关。
引文
[1]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.
[2]王莹,王耀献,刘玉宁,等.NLR和PLR与糖尿病肾脏病[J].中国中西医结合肾病杂志,2016,17(10):870-873.
[3]ALBERTI K G,ZIMMET P Z.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[4]袁磊磊,阚英,王遥,等.以双血浆法为标准评估肾动态显像法与CKD-EPI公式法测定老年慢性肾病患者肾小球滤过率的临床应用研究[J].标记免疫分析与临床,2017,24(11):1205-1208.
[5]DEMIRCELIK M B,KURTUL A,OCEK H,et al.Association between Platelet-to-Lymphocyte ratio and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J].Cardiorenal Med,2015,5(2):96-104.
[6]YING H Q,DENG Q W,HE B S,et al.The prognostic value of preoperative NLR,d-NLR,PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients[J].Med Oncol,2014,31(12):305.
[7]陈琳琳,赵晖.白细胞介素-6对糖尿病酮症酸中毒早期判别预后的作用[J].中华急诊医学杂志,2013,22(12):1394-1397.
[8]李莎,王椿,钟晓卫,等.2型糖尿病患者平均血小板体积变化及其对下肢动脉病变的相关关系[J].中华医学杂志,2012,92(4):232-235.
[9]任焕欣,吴晓明,赵伟,等.外周血血小板与淋巴细胞比值和2型糖尿病肾病的相关性研究[J].中华内分泌代谢杂志,2015,31(5):406-407.
[10]ELLER K,KIRSCH A,WOLFA M,et al.Potential role of regulatory T cells in reversing obesity-linked insulin resistance and diabetic nephropathy[J].Diabetes,2011,60(11):2954-2962.
[11]NAVARRO J F,MORA C,MACAM,et al.Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus[J].Am J Kidney Dis,2003,42(1):53-61.
[12]于璐,张珂珂,王静,等.血小板与淋巴细胞比值在老年人2型糖尿病致肾功能损伤患者中的相关性研究[J].中华老年医学杂志,2018,37(8):883-887.
[13]冯然,刘涛,王宁,等.中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与糖尿病肾病的相关性[J].中国临床研究,2016,29(9):1205-1207.
[14]程光敏,齐向明,徐兴欣,等.慢性肾脏病不同分期患者焦虑抑郁状态研究[J].安徽医学,2018,39(3):349-351.
[15]李涛,田伊茗,魏鹍,等.2型糖尿病患者血小板/淋巴细胞计数比值与糖尿病肾病的相关性[J].国际移植与血液净化杂志,2018,16(1):28-31.
[16]MIMA A.Inflammation and oxidative stress in diabetic nephropathy:new insights on its inhibition as new therapeutic targets[J].J Diabetes Res,2013,2013:248563.
[17]MACHLUS K R,JOHNSON K E,KULENTHIRARAJAN R,et al.CCL5 derived from platelets increases megakaryocyte proplatelet formation[J].Blood,2016,127(7):921-926.
[18]GERDES N,ZHU L,ERSOY M,et al.Platelets regulate CD4+T-cell differentiation via multiple chemokines in humans[J].Thromb Haemost,2011,106(2):353-362.
[19]沈文清,邢艳芳,黄丽,等.微炎症及氧化应激对慢性肾脏病患者肾功能的影响[J].中国临床医学,2010,19(5):500-501.
[20]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,337(9818):815-822.
[21]晏丕军,张志红,徐勇,等.不同e GFR的T2DM患者血清总胆红素变化及与胱抑素C的相关性[J].安徽医科大学学报,2016,51(2):263-267.
[2]王莹,王耀献,刘玉宁,等.NLR和PLR与糖尿病肾脏病[J].中国中西医结合肾病杂志,2016,17(10):870-873.
[3]ALBERTI K G,ZIMMET P Z.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[4]袁磊磊,阚英,王遥,等.以双血浆法为标准评估肾动态显像法与CKD-EPI公式法测定老年慢性肾病患者肾小球滤过率的临床应用研究[J].标记免疫分析与临床,2017,24(11):1205-1208.
[5]DEMIRCELIK M B,KURTUL A,OCEK H,et al.Association between Platelet-to-Lymphocyte ratio and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J].Cardiorenal Med,2015,5(2):96-104.
[6]YING H Q,DENG Q W,HE B S,et al.The prognostic value of preoperative NLR,d-NLR,PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients[J].Med Oncol,2014,31(12):305.
[7]陈琳琳,赵晖.白细胞介素-6对糖尿病酮症酸中毒早期判别预后的作用[J].中华急诊医学杂志,2013,22(12):1394-1397.
[8]李莎,王椿,钟晓卫,等.2型糖尿病患者平均血小板体积变化及其对下肢动脉病变的相关关系[J].中华医学杂志,2012,92(4):232-235.
[9]任焕欣,吴晓明,赵伟,等.外周血血小板与淋巴细胞比值和2型糖尿病肾病的相关性研究[J].中华内分泌代谢杂志,2015,31(5):406-407.
[10]ELLER K,KIRSCH A,WOLFA M,et al.Potential role of regulatory T cells in reversing obesity-linked insulin resistance and diabetic nephropathy[J].Diabetes,2011,60(11):2954-2962.
[11]NAVARRO J F,MORA C,MACAM,et al.Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus[J].Am J Kidney Dis,2003,42(1):53-61.
[12]于璐,张珂珂,王静,等.血小板与淋巴细胞比值在老年人2型糖尿病致肾功能损伤患者中的相关性研究[J].中华老年医学杂志,2018,37(8):883-887.
[13]冯然,刘涛,王宁,等.中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与糖尿病肾病的相关性[J].中国临床研究,2016,29(9):1205-1207.
[14]程光敏,齐向明,徐兴欣,等.慢性肾脏病不同分期患者焦虑抑郁状态研究[J].安徽医学,2018,39(3):349-351.
[15]李涛,田伊茗,魏鹍,等.2型糖尿病患者血小板/淋巴细胞计数比值与糖尿病肾病的相关性[J].国际移植与血液净化杂志,2018,16(1):28-31.
[16]MIMA A.Inflammation and oxidative stress in diabetic nephropathy:new insights on its inhibition as new therapeutic targets[J].J Diabetes Res,2013,2013:248563.
[17]MACHLUS K R,JOHNSON K E,KULENTHIRARAJAN R,et al.CCL5 derived from platelets increases megakaryocyte proplatelet formation[J].Blood,2016,127(7):921-926.
[18]GERDES N,ZHU L,ERSOY M,et al.Platelets regulate CD4+T-cell differentiation via multiple chemokines in humans[J].Thromb Haemost,2011,106(2):353-362.
[19]沈文清,邢艳芳,黄丽,等.微炎症及氧化应激对慢性肾脏病患者肾功能的影响[J].中国临床医学,2010,19(5):500-501.
[20]ZHANG L,WANG F,WANG L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,337(9818):815-822.
[21]晏丕军,张志红,徐勇,等.不同e GFR的T2DM患者血清总胆红素变化及与胱抑素C的相关性[J].安徽医科大学学报,2016,51(2):263-267.