不同中性粒细胞与淋巴细胞比值IgA肾病患者临床特征比较及其影响因素分析
摘要
目的分析中性粒细胞与淋巴细胞比值(NLR)不同水平的Lg A肾病(Ig AN)患者的临床特征,分析影响NLR水平的因素。方法选择Ig AN患者101例,根据NLR水平进行三分位分组,分为低三分位组(NLR≤1. 8354) 33例、中三分位组(NLR 1. 835 5～3. 009 1) 35例、高三分位组(NLR≥3. 009 2) 33例。患者入院时采集清晨空腹外周静脉血,应用血细胞分析仪进行血常规检测,计算NLR、血小板/淋巴细胞比值(PLR);应用全自动生化分析仪检测尿素氮(BUN)、血肌酐、尿酸、总蛋白、白蛋白、总胆固醇、甘油三酯,计算肾小球滤过率(e GFR);采用免疫比浊法检测免疫球蛋白(Ig A、Ig G、Ig M)、补体C3、C4及超敏C反应蛋白;采用魏氏法测定血沉。留取24 h尿液,采用巴赫定量法进行24 h尿蛋白定量。将所有肾活检标本送检病理科行光镜、免疫组化、电镜检查。参照1982年Ig AN Lee氏病理分级标准评价病理分级。参照2017年国际Ig A肾病网络协作组和肾脏病理协会Ig A肾病分类工作组更新的Ig AN牛津分型标准评价肾脏病理特征,包括系膜细胞增殖(M)、肾小球节段硬化(S)、毛细血管内增殖(E)、肾小管萎缩/间质纤维化(T)、细胞/纤维细胞性新月体(C)。结果高三分位组WBC、PLR均高于中三分位组及低三分位组,高三分位组、中三分位组e GFR均低于低三分位组,高三分位组BUN高于低三分位组(P均<0. 05)。低三分位组的病理分级以Ⅰ、Ⅱ级为主,高三分位组的病理分级以Ⅳ、Ⅴ级为主(P <0. 05)。高三分位组肾小管萎缩/间质纤维化T2病变者多于中、低三分位组(P <0. 05)。多元线性回归分析示,NLR水平与Ig AN患者WBC、PLR水平呈正相关,与e GFR呈负相关。结论高NLR水平的Ig AN患者e GFR下降明显、病理分级较重、肾小管萎缩/间质纤维化程度较重。NLR水平受Ig AN患者自身免疫性疾病的炎症状态及疾病活动度影响。
引文
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[11]魏雯,马宏,阴怀清.中性粒细胞与淋巴细胞的比值及嗜酸性粒细胞对过敏性紫癜肾炎的预测价值[J].中国医疗前沿,2011,6(20):55-56.
[12]李卅立,范秋灵,赵洁,等. Ig A肾病牛津分型与临床指标的相关性及危险因素分析[J].中国医科大学学报,2017,46(1):1-6.
[13]Moriyama T,Nakayama K,Iwasaki C,et al. Severity of nephrotic Ig A nephropathy according to the Oxford classification[J]. Int Urol Nephrol,2012,44(4):1177-1184.
[14]Katafuchi R,Ninomiya T,Nagata M,et al. Validation study of oxford classification of Ig A nephropathy:the significance of extracapillary proliferation[J]. Clin J Am Soc Nephrol,2011,6(12):2806-2813.
[15] Coppo R,Troyanov S,Bellur S,et al. Validation of the Oxford classification of Ig A nephropathy in cohorts with different presentations and treatments[J]. Kidney Int,2014,86(4):828-836.
[16]Le W,Zeng CH,Liu Z,et al. Validation of the Oxford classification of Ig A nephropathy for pediatric patients from China[J]. BMC Nephrol,2012,13:158.
[2]Yang DH,Qian MZ,Wei MM,et al. The correlation of neutrophil-to-lymphocyte ratio with the presence and activity of myasthenia gravis[J]. Oncotarget,2017,8(44):76099-76107.
[3]Azab B,Daoud J,Naeem FB,et al. Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients(3-year follow-up study)[J]. Ren Fail,2012,34(5):571-576.
[4]Bene MC,Hurault De Ligny B,Kessler M,et al. Confirmation of tonsillar anomalies in Ig A nephropathy:amulticenter study[J].Nephron,1991,58(4):425-428.
[5]Nagasawa Y,Iio K,Fukuda S,et al. Periodontal disease bacteria specific to tonsil in Ig A nephropathy atients predicts the remission by the treatment[J]. PLo S One,2014,9(1):e81636.
[6]Tossier C,Pilette C,Guilleminault L,et al. Diffuse panbronchiolitis and Ig A nephropathy[J]. Am J Respir Crit Care Med,2014,189(1):106-109.
[7]De Angelis M,Montemurno E,Piccolo M,et al. Microbiota and metabolome associated with immunoglobulin A nephropathy(Ig AN)[J]. PLo S One,2014,9(6):e99006.
[8]Welander A,Sundelin B,Fored M,et al. Increased risk of Ig A nephropathy among individuals with celiac disease[J]. J Clin Gastroenterol,2013,47(8):678-683.
[9]Szigeti N,Kovács T,Degrell P,et al. Secondary Ig A-nephropathy in gastroenterological diseases[J]. Orv Hetil,2007,148(7):313-318.
[10]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.
[11]魏雯,马宏,阴怀清.中性粒细胞与淋巴细胞的比值及嗜酸性粒细胞对过敏性紫癜肾炎的预测价值[J].中国医疗前沿,2011,6(20):55-56.
[12]李卅立,范秋灵,赵洁,等. Ig A肾病牛津分型与临床指标的相关性及危险因素分析[J].中国医科大学学报,2017,46(1):1-6.
[13]Moriyama T,Nakayama K,Iwasaki C,et al. Severity of nephrotic Ig A nephropathy according to the Oxford classification[J]. Int Urol Nephrol,2012,44(4):1177-1184.
[14]Katafuchi R,Ninomiya T,Nagata M,et al. Validation study of oxford classification of Ig A nephropathy:the significance of extracapillary proliferation[J]. Clin J Am Soc Nephrol,2011,6(12):2806-2813.
[15] Coppo R,Troyanov S,Bellur S,et al. Validation of the Oxford classification of Ig A nephropathy in cohorts with different presentations and treatments[J]. Kidney Int,2014,86(4):828-836.
[16]Le W,Zeng CH,Liu Z,et al. Validation of the Oxford classification of Ig A nephropathy for pediatric patients from China[J]. BMC Nephrol,2012,13:158.