淋巴细胞计数、单核细胞与淋巴细胞比值对慢性肾脏病患者心瓣膜钙化及预后的影响

The impact of lymphocyte count and monocyte/lymphocyte ratio on cardiac valve calcification and prognosis in patients with chronic kidney disease

摘要:

目的 探讨慢性肾脏病（CKD）1～5期非透析患者的淋巴细胞计数（LY）、单核细胞与淋巴细胞比值（MLR）对心瓣膜钙化及预后的影响。方法 选取2018年1月1日—2023年12月31日778例因CKD在首都医科大学宣武医院肾内科住院治疗且进行了心脏超声心动图检查的患者，其中，发生心瓣膜钙化的269例，非心瓣膜钙化509例。收集患者的一般情况、基础疾病、白细胞计数、中性粒细胞计数、淋巴细胞计数、单核细胞计数、血红蛋白、血小板计数、纤维蛋白原水平、白蛋白水平、低密度脂蛋白胆固醇水平、总胆固醇水平、血钙水平、血磷水平及全段甲状旁腺素水平。对患者进行随访，随访截止日期为2024年9月1日，终点事件为全因死亡。采用多因素一般Logistic回归分析CKD患者心瓣膜钙化的危险因素，Cox比例风险回归模型分析CKD患者全因死亡的风险因素。结果 778例患者心瓣膜钙化的发生率为34.58%。心瓣膜钙化组较非心瓣膜钙化组年龄大、合并高血压率高、合并糖尿病率高、合并高脂血症率高、CKD 4～5期占比高、MLR升高、白细胞计数低、中性粒细胞计数低、LY低、血红蛋白低、血小板计数低、低密度脂蛋白胆固醇水平低、总胆固醇水平低（P <0.05）。多因素一般Logistic回归分析结果显示：年龄≥60岁［O^R =8.057（95% CI：5.401，12.020）］、MLR高 ［O^R =6.981（95% CI：1.767，27.581）］、CKD 4～5期［O^R =2.128（95% CI：1.404，3.224）］、合并高血压［O^R =1.892（95% CI：1.072，3.342）］、合并高脂血症［O^R =3.312（95% CI：2.280，4.811）］为CKD患者出现心瓣膜钙化的危险因素（P <0.05）。778例患者死亡86例（11.05%），存活614例（78.92%），失访78例（10.03%）。死亡组较存活组的年龄大、CKD 4～5期占比高、LY低、MLR高、血磷高、血钙低、合并高血压率高、合并糖尿病率高、合并心瓣膜钙化率高（P <0.05）。多因素Cox回归模型分析显示：年龄≥60岁［H^R =2.069（95% CI：1.176，3.641）］、合并心瓣膜钙化［H^R =1.745（95% CI：1.084，2.810）］、LY<1.0×10⁹/L ［H^R =1.811（95% CI：1.105，2.968）］、CKD合并糖尿病［H^R =1.994（95% CI：1.257，3.163）］是CKD 1～5期非透析患者全因死亡的危险因素（P <0.05），而MLR≥0.31 ［H^R =1.045（95% CI：0.665，1.643）］不是全因死亡的危险因素（P >0.05）。结论 MLR升高是CKD非透析患者瓣膜钙化的独立危险因素，LY降低为CKD非透析患者全因死亡的独立危险因素，但MLR升高并非与CKD非透析患者全因死亡风险独立相关。

Abstract:

Objective To investigate the effect of lymphocyte count (LY) and monocyte/lymphocyte ratio (MLR) on cardiac valve calcification (CVC) and prognosis in non-dialysis patients with chronic kidney disease (CKD) stages 1-5.Methods From January 1, 2018 to December 31, 2023, 778 patients with CKD who were hospitalized in the Nephrology Department of Xuanwu Hospital of Capital Medical University and underwent echocardiography were selected. Among them, 269 cases had heart valve calcification and 509 cases had non heart valve calcification. Data were collected on the patients' underlying diseases, white blood cell count, neutrophil count, lymphocyte count, monocyte count, hemoglobin, platelet count, fibrinogen level, albumin level, low-density lipoprotein cholesterol level, total cholesterol level, blood calcium level, blood phosphorus level and intact parathyroid hormone level. Patients were followed up until September 1, 2024, with all-cause mortality as the endpoint event. Multivariate general Logistic regression analysis was used to identify the risk factors for valvular calcification in CKD patients, and the Cox proportional hazards regression model was employed to analyze the risk factors for all-cause mortality in CKD patients.Results The incidence of heart valve calcification in 778 patients was 34.58%. Compared with the non-valvular calcification group, the cardiac valve calcification group had older age, higher proportions of hypertension, diabetes, hyperlipidemia, and CKD stage 4-5, higher MLR, and lower levels of white blood cell count, neutrophil count, LY, hemoglobin, platelet count, low-density lipoprotein cholesterol, and total cholesterol (P < 0.05). The results of multivariate logistic analysis showed that age ≥ 60 years [O^R = 8.057 ( 95% CI: 5.401, 12.020) ], MLR [O^R = 6.981 (95% CI: 1.767, 27.581) ], CKD 4-5 stage [O^R = 2.128 (95% CI: 1.404, 3.224) ], concomitant hypertension [O^R = 1.892 (95% CI: 1.072, 3.342) ], and concomitant hyperlipidemia [O^R = 3.312 (95% CI: 2.280, 4.811) ] were risk factors for CVC in CKD patients. Among 778 patients, 86 (11.05%) died, 614 (78.92%) survived, and 78 (10.03%) were lost to follow-up. The death group was older than the survival group, with a high proportion of CKD stage 4-5, low LY, high MLR, high blood phosphorus, low blood calcium, high rate of hypertension, high rate of diabetes, and high rate of cardiac valve calcification (P < 0.05). Multivariate Cox regression analysis showed that: age ≥ 60 years [H^R = 2.069 (95% CI: 1.176, 3.641) ], CVC [H^R = 1.745 (95% CI: 1.084, 2.810) ], LY < 1.0×109/L [H^R = 1.811 (95% CI: 1.105, 2.968) ], CKD combined with diabetes [H^R = 1.994 (95% CI: 1.257, 3.163) ] were risk factors for all-cause death in CKD 1-5 non-dialysis patients (P < 0.05), while MLR ≥ 0.31 [H^R = 1.045 (95% CI: 0.665, 1.643) ] was not a risk factor for all-cause death (P > 0.05).Conclusion Elevated MLR is an independent risk factor for valve calcification in CKD non-dialysis patients, while decreased LY is associated with all-cause mortality in CKD non dialysis patients. However, elevated MLR is not independently associated with the risk of all-cause mortality in CKD non dialysis patients.