摘要
目的 探讨中性粒细胞与淋巴细胞比值(NLR)、血肌酐(Cr)、尿免疫球蛋白G(uIGG)及联合检测对老年2型糖尿病肾病患者的诊断价值.方法 选取2022年1 月至2023年6 月湖州市南浔区人民医院临床确诊为2型糖尿病(T2DM)的老年患者223 例,分为糖尿病肾病(DN)组和T2DM组.比较两组患者一般资料、血常规、超敏C反应蛋白(hs-CRP)、生化、尿肾功能敏感六项指标;采用Pearson相关性分析NLR与各指标的相关性;使用logistic回归分析DN的独立危险因素;应用受试者工作特征(ROC)曲线评价NLR、Cr、uIGG单一检测和联合检测的诊断效能.结果 DN组视网膜病变患病率、病程、同型半胱氨酸(HCY)、尿素氮(BUN)、Cr、尿酸(UA)、NLR、hs-CRP、uIGG、尿α1-微球蛋白(uα1-MG)水平明显高于T2DM组,差异均有统计学意义(χ2=5.38,t分别=-2.52、-3.41、-4.81、-6.18、-4.02、-5.13,Z分别=-2.21、-2.56、-2.13,P均＜0.05).Pearson相关性分析显示,NLR与hs-CRP、HCY、BUN、Cr、UA呈正相关(r分别=0.33、0.30、0.36、0.45、0.27,P均＜0.05).logistic回归模型分析显示,合并视网膜病变、病程长、高Cr、高NLR、高uIGG水平是DN的独立危险因素(OR分别=13.22、1.08、1.03、1.66、1.01,P均＜0.05).将NLR、Cr、uIGG作为检验诊断指标,NLR+Cr联合检测时,其曲线下面积最大(0.82),灵敏度为88.46%,特异度为75.63%.结论 NLR和Cr联合检测能明显提高DN的诊断能力,为临床早期诊断提供依据.
Abstract
Objective To investigate the diagnostic value of neutrophil-lymphocyte ratio,serum creatinine,urine im-munoglobulin G and combined detection in elderly patients with type 2 diabetic nephropathy.Methods A total of 223 elderly patients clinically diagnosed with type 2 diabetes mellitus(T2DM)in Nanxun District People's Hospital of Hu-zhou City from January 2022 to June 2023 were selected and divided into diabetic nephropathy(DN)group and simple T2DM group.The general data,blood routine,hypersensitive C-reactive protein(hs-CRP),biochemistry and urine and kidney function were compared between the two groups.Pearson correlation was used to analyze the correlation between neutrophil-lymphocyte ratio(NLR)and various indicators.Logistic regression analysis was used to analyze the indepen-dent risk factors of DN.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of single and combined detection.Results The morbidity of retinopathy,course of disease,homocysteine(HCY),urea ni-trogen(BUN),creatinine(Cr),uric acid(UA),NLR,hs-CRP,urine immunoglobulin G(uIGG),and urine α1-micro-globulin(uα1-MG)levels were significantly higher than those in the T2DM group,and the differences were statistically significant(χ2=5.38,t=-2.52,-3.41,-4.81,-6.18,-4.02,-5.13,Z=-2.21,-2.56,-2.13,P＜0.05).Pearson correlation analysis showed that NLR was positively correlated with hs-CRP,HCY,BUN,Cr,and UA(r=0.33,0.30,0.36,0.45,0.27,P＜0.05).Logistic regression analysis showed that retinopathy,longer course of disease,higher Cr,NLR,and uIGG levels were independent risk factors for DN(OR=13.22,1.08,1.03,1.66,1.01,P＜0.05).The area under the curve of NLR and Cr combined detection was the largest(0.82),the sensitivity was 88.46%,and the specificity was 75.63%.Conclusion The combined detection of NLR and Cr can significantly improve the diag-nostic ability of DN and provide a basis for early clinical diagnosis.
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