IgA肾病患者外周血中性粒细胞与淋巴细胞比值的临床意义

Clinical significance of peripheral blood neutrophil-lymphocyte ratio in patients with IgA nephropathy

摘要:

目的 炎症与IgA肾病（IgAN）的发病机制密切相关，并可能影响血清中性粒细胞-淋巴细胞比值（NLR）。研究旨在探讨NLR与IgAN患者的临床病理表现和预后之间的关系。方法 收集2014年12月—2018年6月于郑州大学第一附属医院肾内科行肾穿刺确诊的397例原发性IgAN患者的临床病理资料，根据NLR中位数（2.01）分为两组，分析不同组之间临床指标、病理特征的差异。回顾性比较两组患者的临床病理特征，采用Kaplan-Meier法评估肾脏累计生存率，Cox比例风险模型分析NLR在IgAN患者肾病进展中的预后价值。结果 NLR高水平组的血清尿素氮、肌酐、尿酸和24 h尿蛋白总量较高（P <0.05）；肾小球内皮细胞增生和肾小管出现萎缩/肾间质纤维化程度更为严重（P <0.05），治疗后的缓解率较低（P <0.05）。Kaplan-Meier生存曲线结果表明，NLR高水平组肾脏总的生存率低于NLR低水平组（P <0.05）；经过多因素校正后，NLR不是影响IgAN患者预后的独立危险因素（P >0.05）。结论 作为一种方便有效的指标，NLR可作为评估IgAN严重程度的参考；NLR不是影响IgAN患者预后的独立危险因素。

Abstract:

Objective Inflammation is closely related with the pathogenesis of IgA nephropathy (IgAN) and may affects the serum neutrophil-lymphocyte ratio (NLR). This study aimed to investigate the relationships between NLR and clinicopathological manifestations and galactose-deficiency IgA1 (Gd-IgA1).Methods Clinical and pathological indicators were collected from 397 patients with IgAN from December 2014 to June 2018 in our hospital. According to the median level of NLR (2.01), they were divided into two groups. The clinical and pathologic differences and treatment effect between the two groups were analyzed. Log rank test and Kaplan Meier curve, as well as multivariate Cox proportional hazard model were made to show the prognosis between the two groups.Results Serum blood urea nitrogen, creatinine, uric acid, and 24-hour total urine protein levels were higher in the high NLR group (P < 0.05); what is more, patients with high NLR levels had more severe glomerular endothelial cell hyperplasia, more severe tubular atrophy / renal interstitial fibrosis (P < 0.05), and lower remission rate after treatment (P < 0.05). Kaplan-Meier survival analysis showed that the cumulative survival rate of kidney in the high NLR levels group was lower than that in the low NLR levels group (P < 0.05). After multivariate adjustment, NLR is not an independent risk factor for IgAN patients (P > 0.05).Conclusions As a convenient and effective indicator, NLR can be used as a reference for assessing the clinical pathological severity of IgAN; it is not an independent risk factor affecting the prognosis of IgAN patients.