中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对腹膜透析患者腹主动脉钙化的评估价值

目的探讨中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对腹膜透析患者腹主动脉钙化(abdominal aortic calcification,AAC)的评估价值。方法选取2018年9月至2019年10月在青岛市市立医院行规律腹膜透析的慢性肾脏病5期患者72例,收集患者的一般指标及临床生化指标并计算NLR和PLR值,采用腹部侧位平片测定AAC评分,将患者分为两组:无或轻度钙化组(0≤AAC评分≤4分)及中重度钙化组(AAC评分>4分),分析AAC评分、NLR、PLR与临床指标的相关性及NLR、PLR对中重度AAC的评估价值。结果腹膜透析患者钙化比例为83.3%,中重度钙化比例为52.8%;中重度钙化组患者的年龄、透析龄、中性粒细胞计数、血小板计数、淋巴细胞计数、NLR、PLR、白蛋白、矫正钙、钙磷乘积、碱性磷酸酶、C反应蛋白(C-reactive protein,CRP)、三酰甘油与无或轻度钙化组比较,差异有统计学意义(P<0.05);AAC评分与年龄、透析龄、中性粒细胞计数、血小板、NLR、PLR、血磷、矫正钙、钙磷乘积、碱性磷酸酶、CRP、三酰甘油呈正相关,与白蛋白、淋巴细胞计数呈负相关(P<0.05);NLR与年龄、中性粒细胞计数、碱性磷酸酶、CRP、AAC评分呈正相关(P<0.05),与淋巴细胞计数、白蛋白呈负相关(P<0.05);PLR与年龄、中性粒细胞计数、血小板计数、CRP、AAC评分呈正相关(P<0.05),与淋巴细胞计数、白蛋白呈负相关(P<0.05)。NLR和PLR诊断中重度AAC的ROC曲线结果显示,NLR曲线下面积为0.844(截点3.88,敏感度0.868,特异性0.706),PLR曲线下面积为0.784(截点193.03,敏感度0.763,特异性0.735)。结论NLR及PLR都与腹膜透析患者AAC及炎症状态有关,NLR对腹膜透析患者AAC有更好的诊断价值。

Evaluations of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios for abdominal aortic calcification in peritoneal dialysis patients

Objective To explore the value of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in the evaluation of abdominal aortic calcification(AAC)in peritoneal dialysis(PD)patients.Methods From 2018 to 2019,a total of 72 patients with chronic kidney disease(CKD)in stage 5 undergoing regular PD at Qingdao Municipal Hospital were recruited.Their general and clinical biochemical parameters were collected and the values of NLR/PLR calculated.Based upon AAC scores,they were divided into non/mild calcification group(0≤AACs≤4)and moderate-severe group(AACs>4).For elucidating the correlation between AAC,NLR and PLR,clinical parameters and diagnostic values of NLR/PLR for moderate-severe AAC were examined.Results The proportion of calcification was 83.3%and the proportion of moderate-severe calcification 52.8%.Significant inter-group differences existed in age,dialytic age,counts of neutrophil/platelet/lymphocyte,NLR,PLR,albumin,corrected calcium,calcium-phosphorus product,alkaline phosphatase,C-reactive protein(CRP)and triglyceride(TG)(P<0.05).AAC was positively correlated with age,dialytic age,neutrophils,platelets,NLR,PLR,blood phosphorus,corrected calcium,calcium-phosphorus product,alkaline phosphatase,CRP,TG(P<0.05)and negatively correlated with albumin and lymphocyte count(P<0.05).NLR was positively correlated with age,neutrophil count,alkaline phosphatase,CRP and AACS(P<0.05)while negatively correlated with lymphocyte count and albumin(P<0.05).PLR was positively correlated with age,neutrophil count,platelet count,CRP and AACs(P<0.05)while negatively correlated with lymphocyte count and albumin(P<0.05).The area under ROC curve of NLR/PLR for moderate/severe abdominal aortic calcification was 0.844(cutoff point 3.88,sensitivity 0.868,specificity 0.706)and PLR curve 0.784(cutoff point 193.03,sensitivity 0.763,specificity 0.735).Conclusions Both NLR and PLR are correlated with AAC and inflammation in PD patients.Yet NLR has a better diagnostic value for AAC in PD patients.