中性粒细胞/淋巴细胞比值与老年维持性血液透析病人预后的关系

doi:10.3969/j.issn.1003-9198.2024.04.011

摘要/Abstract

摘要： 目的探讨中性粒细胞/淋巴细胞比值(NLR)与老年维持性血液透析(MHD)病人不良结局的关系。方法选取2017—2021年于德阳市人民医院肾病内科血液净化中心接受MHD治疗的140例老年病人,根据随访期间病人是否死亡分为死亡组和生存组。比较2组病人开始行MHD时的临床资料及实验室指标;采用Cox比例风险回归模型分析影响老年MHD病人预后的危险因素,同时采用ROC曲线评估危险因素对老年MHD病人不良预后的预测效能。结果与生存组相比,死亡组透析龄更短,血红蛋白、淋巴细胞水平更低,NLR、血小板／淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、hs-CRP水平更高,差异均有统计学意义(P＜0.05)。校正多项混杂因素后,多因素Cox回归分析表明,NLR、合并糖尿病、低血红蛋白是影响老年MHD病人生存的独立危险因素。ROC曲线结果显示,NLR能够较好地预测老年MHD病人不良预后,最佳截断值为7.66,灵敏度为60%,特异度为91%,AUC为0.756(P＜0.01)。结论 NLR是影响老年MHD病人预后的独立危险因素,其预测老年MHD不良预后的特异性较高。

关键词: 维持性血液透析, 中性粒细胞/淋巴细胞比值, 老年人, 预后

Abstract: Objective To investigate the relationship of neutrophil to lymphocyte ratio (NLR) with adverse outcomes in the elderly patients undergoing maintenance hemodialysis (MHD). Methods A total of 140 elderly patients who received MHD treatment at Blood Purification Center of Deyang People's Hospital from January 2017 to December 2021 were retrospectively enrolled in this study. According to whether the patients died during the follow-up period, they were divided into the death group and the survival group. The clinical data and laboratory indicators of the patients before MHD were compared between the two groups. Cox proportional risk regression model was used to analyze the risk factors affecting the survival time of elderly patients undergoing MHD, and receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the risk factors for prognosis of the patients. Results Compared with the survival group, the death group had shorter dialysis time, lower levels of hemoglobin and lymphocytes, and higher levels of NLR, platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and hypersensitive C-reactive protein (P<0.05). After adjusting multiple confounding factors, multivariate COX regression analysis showed that NLR, diabetes and low level of hemoglobin were independent risk factors affecting the survival time of elderly patients undergoing MHD. ROC curve results showed that 7.66 was the best cutoff point of NLR in predicting the poor prognosis of the patients (P<0.01), with a sensitivity of 60%, a specificity of 91%, and an area under the ROC curve of 0.756 (P<0.01). Conclusions NLR is an independent risk factor that affects the survival time of the elderly MHD patients, and could effectively predict the risk of adverse prognosis in the patients.

Key words: maintenance hemodialysis, neutrophil to lymphocyte ratio, aged, prognosis

中图分类号:

肖文, 胡秀, 李隽, 宋斌. 中性粒细胞/淋巴细胞比值与老年维持性血液透析病人预后的关系[J]. 实用老年医学, 2024, 38(4): 372-376.

XIAO Wen, HU Xiu, LI Jun, SONG Bin. Relationship of neutrophil to lymphocyte ratio with prognosis of elderly patients undergoing maintenance hemodialysis[J]. Practical Geriatrics, 2024, 38(4): 372-376.

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