中性粒细胞与淋巴细胞比值联合尿白蛋白与肌酐比值诊断糖尿病肾病的临床价值

Value of neutrophils-to-lymphocyte ratio combined with urine albumin to creatinine ratio in diagnosis of diabetic nephropathy

摘要:

目的 探讨糖尿病肾病（DN）患者外周血中性粒细胞与淋巴细胞比值（NLR）、尿白蛋白与肌酐比值（UACR）的变化及临床意义。方法 随机选取2021年2月—2022年8月青海省人民医院收治的DN患者共80例为DN组，同时选取同期收治的单纯2型糖尿病（T2DM）患者80例为T2DM组。收集两组患者的外周血及尿液标本进行血常规、血生化及尿蛋白检测，比较两组患者实验室检查结果；Pearson相关性分析NLR与UACR的相关性；绘制受试者工作特征（ROC）曲线分析NLR与UACR对DN的诊断效能。结果 两组患者的临床资料比较，差异无统计学意义（P >0.05）；DN组UACR、NLR、BUN、eGFR、Cr、尿mALB、尿α1微球蛋白及24 h尿蛋白水平均高于T2DM组（P <0.05）；UACR与NLR（r =0.391，P =0.027）、24 h尿蛋白（r =0.473，P =0.000）、Cr（r =0.289，P =0.036）及尿mALB（r =0.317，P =0.045）呈正相关，与eGFR（r =-0.572，P =0.014）呈负相关；ROC曲线分析结果显示，NLR联合UACR诊断DN的曲线下面积（AUC）为0.843（95% CI：0.787，0.886），敏感性为71.52%（95% CI：0.673，0.791），特异性为92.05%（95% CI：0.847，0.986）。结论 DN患者的NLR及UACR显著升高，NLR及UACR呈正相关，两者联合对DN的诊断效能最高。

Abstract:

Objective To investigate the changes and clinical significance of neutrophil-to-lymphocyte ratio (NLR) and urine albumin to creatinine ratio (UACR) in patients with diabetic nephropathy (DN).Methods A total of 80 cases of DN patients admitted to the Department of Endocrinology of our hospital from February 2021 to August 2022 were randomly enrolled into the DN group, and 80 patients with simple type 2 diabetes mellitus (T2DM) hospitalized in our department were enrolled in the same period to be classified as the T2DM group, and peripheral blood and urine samples of the two groups were collected for blood routine. Blood biochemistry, urine protein detection, and the laboratory test results of the two groups were compared, and the correlation between NLR and UACR was analyzed by Pearson. The receiver operating characteristic (ROC) curve analyzed the clinical value of NLR and UACR in diagnosing DN.Results There was no significant difference in the basic clinical data of the two groups (P > 0.05); Compared with the T2DM group, the difference between UACR, NLR, BUN, eGFR, Cr, mALB, urine microglobulin, and 24h urine protein in DN group were statistically significant, and the all of indexes in DN group were higher than T2DM group (all P < 0.05); Pearson correlation analysis showed that UACR was significantly positively correlated with NLR, 24 h urine protein, Cr and urine ALB (r = 0.391, 0.473, 0.289 and 0.317, P =0.027, 0.000, 0.036 and 0.045), while negatively correlated with GFR (r = -0.572, P =0.014); the ROC curve shows that NLR combined with UACR has the highest clinical value in the diagnosis of DN, and the area under the curve (AUC) was 0.843 (95% CI: 0.787, 0.886).Conclusion NLR and UACR are significantly increased in DN patients, and there is a positive relationship between the two, and the clinical value of the combination of these two indicators in diagnosing DN is the highest.