Combined diagnostic value of NLR,PLR and Lp-PLA2 for protein energy consumption in maintenance hemodialysis patients
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目的 探讨中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet/lymphocyte ratio,PLR)、脂蛋白相关磷脂酶A2(lipoprotein phospholipase A2,Lp-PLA2)在维持性血液透析(maintenance hemodialysis,MHD)患者蛋白质能量消耗(protein energy wasting,PEW)的联合诊断价值.方法 收集泰州市人民医院327例接受MHD治疗患者临床资料,根据国际肾脏营养和代谢学会(international society of renal nutrition and metabolism,ISRNM)诊断标准,将MHD患者分为PEW组和非PEW组.探索NLR、PLR、Lp-PLA2在MHD患者PEW诊断中的应用价值.结果 327例患者中有101例患者发生PEW,发生率为31％.PEW组患者体质量指数(body mass index,BMI)、白蛋白、前白蛋白、总胆固醇、肌酐、尿酸水平均低于非PEW组患者(Z/t=-5.358、-8.147、-5.363、-2.297、-4.168、-2.326,P＜0.001、＜0.001、＜0.001、0.022、＜0.001、0.020),年龄、NLR、PLR、Lp-PLA2水平均高于非PEW组(Z/t=-2.753、-5.588、-4.672、-9.269,P=0.006、＜0.001、＜0.001、＜0.001).多因素二元Logistic逐步回归方程分析结果显示NLR(OR=1.094,95％CI:1.004～1.192,P=0.041)、PLR(OR=1.021,95％CI:1.009～1.033,P＜0.001)、Lp-PLA2(OR=1.085,95％CI:1.056～1.114,P＜0.001)水平是血液透析患者发生 PEW 的独立风险因子.NLR(95％CI:0.631～0.756,P＜0.001)、PLR(95％CI:0.597～0.726,P＜0.001)、Lp-PLA2(95％CI:0.735～0.841,P＜0.001)、NLR联合PLR(95％CI:0.650～0.775,P＜0.001)、NLR联合Lp-PLA2(95％CI:0.800～0.889,P＜0.001)、PLR联合Lp-PLA2(95％CI:0.782～0.875,P＜0.001)、NLR联合PLR及 Lp-PLA2(95％CI:0.809～0.895,P＜0.001)在 ROC 曲线下面积分别为 0.693、0.662、0.788、0.713、0.844、0.829、0.852,NLR、PLR、Lp-PLA2 均对MHD 患者发生PEW具有一定的诊断价值,且当三者联合时ROC曲线下面积为0.852(95％CI:0.809～0.895,P＜0.001),诊断效能最大.结论 NLR、PLR、Lp-PLA2水平可作为MHD患者发生PEW的参考指标,加强对NLR、PLR、Lp-PLA2水平的联合监测可为PEW的诊断及治疗提供干预证据.
Objective To investigate the value of neutrophil/lymphocyte ratio(NLR),Platelet/lympho-cyte ratio(PLR)and serum lipoprotein phospholipase A2(Lp-PLA2)in the diagnosis of protein energy wast-ing in patients undergoing maintenance hemodialysis(MHD).Methods Clinical data of 327 patients with end stage renal disease(ESRD)who received MHD treatment in Taizhou People's Hospital were collected.Ac-cording to the International Society of Renal Nutrition and metabolism the patients with MHD who developed PEW were divided into PEW and non-PEW groups.The application values of NLR,PLR,and serum Lp-PLA2 in the diagnosis of PEW in MHD patients were compared.Results In the PEW group,Body Mass In-dex(BMI)(Z=-5.358,P＜0.001),albumin(Z=-8.147,P＜0.001),prealbumin(Z=-5.363,P＜0.001),total cho-lesterol(Z=-2.297,P=0.022),creatinine(Z=-4.168,P＜0.001),uric acid(t=-2.326,P=0.020)levels were sig-nificantly lower than those in non-Pew group,age(Z=-2.753,P=0.006),NLR(Z=-5.588,NLR(Z=-5.588,P=0.020),and NLR(Z=-4.168,P＜0.001)were significantly lower than those in non-Pew group,P＜0.001),PLR(Z=-4.672,P＜0.001)and Lp-PLA2(t=-9.269,P＜0.001)levels were significantly higher than those in non-Pew group.The results of multivariate binary Logistic stepwise regression equation analysis showed that NLR(OR=1.094,95％CI:1.004～1.192,P=0.041),PLR(OR=1.021,95％CI:1.009～1.033,＜0.001),Lp-PLA2(OR=1.085,95％CI:1.056～1.114,P＜0.001)levels were independent risk factors for PEW in hemodialysis patients.NLR(95％CI:0.631～0.756,P＜0.001),PLR(95％CI:0.597～0.726,P＜0.001),Lp-PLA2(95％CI:0.735～0.841,P＜0.001),NLR combined PLR(95％CI:0.631～0.756,P＜0.001)0.650～0.775,P＜0.001),NLR combined with Lp-PLA2(95％CI:0.800～0.889,P＜0.001),PLR combined with Lp-PLA2(95％CI:0.782～0.875,P＜0.001),NLR combined with PLR and Lp-PLA2(95％CI:0.809～0.895,P＜0.001)area under ROC curve were 0.693,0.662,0.788,0.713,0.844,0.829,0.852,respectively.NLR,PLR,Lp-PLA2 all had certain diagnostic value for the occurrence of PEW in MHD patients.The area under ROC curve was 0.852(95％CI:0.809～0.895,P＜0.001)when the three combined,indicating the maximum diagnostic effi-ciency.Conclusion NLR,PLR and serum Lp-PLA2 levels can be used as reference indicators for PEW in MHD patients,and strengthening the joint monitoring of NLR,PLR and serum Lp-PLA2 levels can provide intervention evidence for the diagnosis and treatment of PEW.
Protein energy consumptionMaintenance hemodialysisNeutrophil/lymphocyte ratioPlatelet/lymphocyte ratioLipoprotein phospholipase A2
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