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目的研究2型糖尿病(T2DM)肾病合并肾功能损伤患者中性粒细胞及淋巴细胞绝对值、中性粒细胞与淋巴细胞绝对值比值(NLR)的变化,探讨NLR与肾功能损伤的相关性。方法选取2014-2016年在天津市海洋石油总医院内分泌肾内科住院的280例T2DM患者为研究对象,参照美国《慢性肾脏病及透析的临床实践指南》(K-DOQI指南)中关于肾功能损伤的判断标准,将患者分为3组,糖尿病肾病合并肾功能损伤组(A组)100例,糖尿病肾病无肾功能损伤组(B组)100例和单纯T2DM组(未并发糖尿病肾病或合并其他任何肾病,且无肾功能损伤,C组)80例。收集3组患者的临床资料,测定中性粒细胞绝对值(N)、淋巴细胞绝对值(L)、单核细胞绝对值(M)等,并计算NLR、单核细胞与淋巴细胞绝对值比值(MLR)。用SPSS 19.0软件进行方差分析、χ~2检验,用Pearson相关分析NLR与肾功能相关指标的关系,用多因素logistic回归分析糖尿病肾病合并肾功能损伤的危险因素。结果 A组NLR(2.44±0.73)明显高于B组(1.85±0.77)和C组(1.67±0.54),差异均有统计学意义(P<0.01),B组和C组比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,NLR(OR=2.934,95%CI∶1.349~6.377,P<0.01)和年龄增长(OR=1.186,95%CI∶1.104~1.274,P<0.01)是糖尿病肾病合并肾功能损伤的独立危险因素。NLR与胱抑素C(Cys-C)、血清尿素氮(BUN)、血清肌酐(Cr)和血清尿酸(UA)呈正相关(r值分别为0.338、0.281、0.349和0.159,P<0.05,P<0.01),与肾小球滤过率(e GFR)呈负相关(r=-0.392,P<0.01)。结论T2DM患者NLR升高与肾功能损伤密切相关,是糖尿病肾病合并肾功能损伤的独立危险因素。
Objective To study the absolute value of neutrophils and lymphocytes, the ratio of absolute neutrophil to lymphocyte (NLR) in patients with type 2 diabetes mellitus (T2DM) nephropathy complicated with renal injury, and to explore the correlation between NLR and renal dysfunction. Methods A total of 280 T2DM patients admitted to Department of Endocrinology and Nephrology in Tianjin General Hospital of PetroChina from 2014 to 2016 were enrolled in this study. According to the K-DOQI Guidelines for Chronic Kidney Diseases and Dialysis 100 cases of diabetic nephropathy with renal dysfunction (group A), 100 cases of diabetic nephropathy without renal dysfunction (group B) and T2DM group (without diabetic nephropathy or with other Any kidney disease, and no renal damage, C group) 80 cases. The clinical data of three groups were collected to determine the absolute value of neutrophils (N), the absolute value of lymphocytes (L), the absolute value of monocytes (M), and calculate the absolute value of the ratio of NLR, monocytes and lymphocytes (MLR). ANOVA and χ ~ 2 test were performed using SPSS 19.0 software. Pearson correlation analysis was used to analyze the relationship between NLR and renal function-related indicators. Multivariate logistic regression was used to analyze the risk factors of diabetic nephropathy with renal impairment. Results The NLR in group A (2.44 ± 0.73) was significantly higher than that in group B (1.85 ± 0.77) and group C (1.67 ± 0.54), the difference was statistically significant (P <0.01). There was no statistical difference between group B and group C Significance (P> 0.05). Multivariate logistic regression analysis showed that NLR (OR = 2.934,95% CI: 1.349 ~ 6.377, P <0.01) and age (OR = 1.186,95% CI: 1.104-1.274, P <0.01) were associated with diabetic nephropathy Independent risk factors for renal impairment. NLR was positively correlated with Cys-C, BUN, Cr and UA (r = 0.338, 0.281, 0.349 and 0.159 respectively, P <0.05, P <0.01), and had a negative correlation with glomerular filtration rate (e GFR) (r = -0.392, P <0.01). Conclusion The increased NLR in T2DM patients is closely related to renal dysfunction and is an independent risk factor for diabetic nephropathy with renal impairment.