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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (09) : 972 -979. doi: 10.3877/cma.j.issn.1674-0785.2023.09.008

临床研究

IgA肾病患者中性粒细胞-淋巴细胞比值与肾小管萎缩/间质纤维化相关性分析
吴萌, 吴国仲, 王贵红, 端靓靓, 施杰, 王旭, 余婷, 刘伟†()   
  1. 246001　安庆，安庆市立医院肾内科;246001　安庆，安徽医科大学安庆医学中心
    246001　安庆，安庆市立医院风湿免疫科;246001　安庆，安徽医科大学安庆医学中心
  • 收稿日期:2023-04-17 出版日期:2023-09-15
  • 通信作者: 刘伟
  • 基金资助:
    安徽省高校自然科学研究项目(2022AH040324)

Correlation between neutrophil-lymphocyte ratio and renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy

Meng Wu, Guozhong Wu, Guihong Wang, Liangliang Duan, Jie Shi, Xu Wang, Ting Yu, Wei Liu†()   

  1. Department of Nephrology, Anqing Municipal Hospital, Anqing 246001, China;Anqing Medical Center of Anhui Medical University, Anqing 246001, China
    Department of Rheumatology, Anqing Municipal Hospital, Anqing 246001, China;Anqing Medical Center of Anhui Medical University, Anqing 246001, China
  • Received:2023-04-17 Published:2023-09-15
  • Corresponding author: Wei Liu
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引用本文：

吴萌, 吴国仲, 王贵红, 端靓靓, 施杰, 王旭, 余婷, 刘伟. IgA肾病患者中性粒细胞-淋巴细胞比值与肾小管萎缩/间质纤维化相关性分析[J]. 中华临床医师杂志(电子版), 2023, 17(09): 972-979.

Meng Wu, Guozhong Wu, Guihong Wang, Liangliang Duan, Jie Shi, Xu Wang, Ting Yu, Wei Liu. Correlation between neutrophil-lymphocyte ratio and renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(09): 972-979.

目的

探讨IgA肾病（IgAN）患者中性粒细胞-淋巴细胞比值（NLR）与肾小管萎缩/间质纤维化的相关性，从而明确NLR能否作为评估IgAN疾病严重程度的参考指标。

方法

纳入2018年1月至2023年2月在安庆市立医院肾内科经肾活检确诊的161例原发性IgAN患者；根据NLR中位数将患者分为2组，比较2组之间临床指标及病理特征差异性；采用Spearman秩相关性分析法分析NLR与肾小管萎缩/间质纤维化的相关性；采用一元和多元线性回归模型分析肾小管萎缩/间质纤维化的相关因素；采用ROC曲线评估NLR预测IgAN患者中重度肾小管萎缩/间质纤维化的最佳截断值、敏感性和特异性。

结果

高NLR组收缩压、舒张压、白细胞计数、中性粒细胞计数、血尿素氮、血肌酐、24 h尿蛋白定量均高于低NLR组，淋巴细胞计数、血红蛋白、估算的肾小球滤过率（eGFR）均低于低NLR组（P<0.05)；高NLR组肾小球硬化率、肾小管萎缩/间质纤维化率、T1+T2比例均高于低NLR组（P<0.05)；Spearman秩相关分析结果显示，IgAN患者NLR水平和肾小管萎缩/间质纤维化率呈正相关（r=0.440，P<0.001）；经过多元线性回归模型控制相关混杂因素后发现NLR与肾小管萎缩/间质纤维化程度呈独立显著正相关（β=0.155，t=2.539，P=0.012）；ROC曲线分析结果显示NLR水平预测患者发生中重度肾小管萎缩/间质纤维化的最佳截断值为1.946，曲线下面积为0.719，敏感度和特异度分别为84.80%和57.00%。

结论

NLR与IgAN患者肾小管萎缩/间质纤维化程度密切相关，可作为评估IgAN疾病严重程度的参考指标。

关键词: IgA肾病, 中性粒细胞-淋巴细胞比值, 肾小管萎缩, 肾间质纤维化
Objective

To explore the relationship between the neutrophil-lymphocyte ratio (NLR) and renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy (IgAN) and investigate whether NLR can be used as an indicator to assess the severity of IgAN.

Methods

A total of 161 patients with primary IgAN confirmed by renal biopsy who were admitted to the Department of Nephrology of Anqing Municipal Hospital from January 2018 to February 2023 were included in the study. The patients were divided into two groups according to the median NLR. The clinical indicators and pathological features were compared between the two groups, and the correlation between the NLR and renal tubular atrophy/interstitial fibrosis was assessed by Spearman rank correlation analysis. Univariate and multivariate linear regression analysis were used to analyze the factors associated with renal tubular atrophy/interstitial fibrosis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the optimal cut-off value, sensitivity, and specificity of NLR for predicting moderate to severe renal tubular atrophy/interstitial fibrosis in patients with IgAN.

Results

The systolic blood pressure, diastolic blood pressure, white blood cell count, neutrophil count, urea nitrogen, creatinine, and 24-h urine protein level increased and the lymphocyte count, hemoglobin, and eGFR decreased with the increase of the NLR level (P<0.05). The percentages of patients glomerulosclerosis, renal tubular atrophy/interstitial fibrosis, and T1+T2 lesions were higher in patients with a higher level of NLR (P<0.05). The results of Spearman rank correlation analysis showed that there was a correlation between the levels of NLR and the percentage of patients with renal tubular atrophy/interstitial fibrosis in patients with IgAN (r=0.440, P<0.001). Multiple linear regression analysis showed that NLR was independently and positively associated with the degree of renal tubular atrophy/interstitial fibrosis in patients with IgAN (β=0.155, t=2.539, P=0.012). ROC curve analysis showed that the optimal cut-off value of NLR to predict moderate to severe renal tubular atrophy/interstitial fibrosis was 1.946 and the area under the curve was 0.719 with a sensitivity of 84.80% and specificity of 57.00%.

Conclusion

NLR is closely related to renal tubular atrophy/interstitial fibrosis in patients with IgAN and can be used as a marker to assess the severity of IgAN.

Key words: IgA nephropathy, Neutrophil-lymphocyte ratio, Renal tubular atrophy, Renal interstitial fibrosis
表1 2组IgA肾病患者临床资料比较（161例）
项目 低NLR组（80例） 高NLR组（81例） 统计值 P值
年龄（岁，） 38.48±11.91 40.83±11.75 χ2=-1.247 0.213
男性[例（%）] 33（41.3） 27（33.3） χ2=1.079 0.299
病程（月） 1.0（0.3，12.0） 5.0（0.7，12.0） χ2=-1.888 0.059
收缩压（mmHg，） 125.46±15.17 136.74±19.64 t=-4.080 <0.001
舒张压（mmHg，） 83.98±11.53 89.11±13.04 t=-2.646 0.009
BMI（kg/m2，） 24.13±3.46 23.65±3.44 t=0.898 0.371
白细胞计数（109/L，） 6.07±1.50 7.03±1.79 t=-3.708 <0.001
淋巴细胞计数（109/L，） 2.23±0.64 1.67±0.52 Z=-5.859 <0.001
中性粒细胞计数（109/L，） 3.26±0.88 4.74±1.41 Z=-6.946 <0.001
红细胞计数（1012/L，） 4.25±0.54 4.12±0.54 Z=-1.459 0.145
血红蛋白（g/L，） 126.79±14.90 120.74±18.37 Z=-2.053 0.040
血小板计数（109/L，） 209.66±60.73 205.54±57.78 t=0.441 0.660
白蛋白（g/L，） 38.03±6.79 37.76±5.02 Z=-0.898 0.369
尿素氮（mmol/L，） 5.66±1.87 6.69±2.76 Z=-2.545 0.011
血肌酐（umol/L，） 80.81±31.20 112.04±66.12 Z=-3.150 0.002
eGFR（ml/min/1.73m2，） 97.52±25.44 76.37±32.26 Z=-4.230 <0.001
血尿酸（umol/L，） 365.39±96.80 375.21±99.84 Z=-0.659 0.510
总胆固醇（mmol/L，） 4.76±1.22 4.70±1.39 Z=-0.536 0.592
甘油三酯（mmol/L，） 1.89±1.53 1.79±1.03 Z=-0.074 0.941
高密度脂蛋白（mmol/L，） 1.28±0.51 1.34±0.71 Z=-0.363 0.716
低密度脂蛋白（mmol/L，） 2.62±1.13 2.49±1.11 Z=-0.783 0.434
24 h尿蛋白定量（g/24 h，） 1.60±1.39 2.01±1.47 Z=-2.215 0.027
尿液红细胞计数（μL） 51.50（17.45，109.42） 48.50（10.80，184.60） Z=-0.088 0.930
表2 2组IgA肾病患者病例特征比较（161例）
项目 低NLR组（80例） 高NLR组（81例） 统计值 P值
肾小球硬化率（%） 11.4（4.6~24.6） 23.1（11.1~42.3） Z=-3.905 <0.001
肾小管萎缩/间质纤维化率（%） 7.5（5.0~15.0） 20.0（10.0~30.0） Z=-6.016 <0.001
新月体率（%） 3.4（0.0~10.8） 5.9（0.0~13.9） Z=-1.754 0.079
牛津分型[例（%）]
M1 80（100.0） 80（98.8） χ2=0.994 0.319
E1 36（45.0） 38（46.9） χ2=0.059 0.808
S1 51（63.7） 50（61.7） χ2=0.070 0.791
T1+T2 6（7.5） 27（33.3） χ2=16.483 <0.001
C1+C2 45（56.3） 55（67.9） χ2=2.322 0.128
图1 NLR、肾小管萎缩/间质纤维化率、eGFR、24h尿蛋白定量之间相关性分析
表3 IgA肾病肾小管萎缩/间质纤维化程度相关因素的多元线性回归分析
自变量 未标准化系数 标准化系数 t值 P值
B 标准误差 β
收缩压（mmHg） 0.055 0.06 0.076 0.918 0.36
舒张压（mmHg） 0.119 0.089 0.11 1.338 0.183
NLR 1.672 0.659 0.155 2.539 0.012
血红蛋白（g/L） -0.117 0.05 -0.147 -2.327 0.021
eGFR（ml/min/1.73m2） -0.207 0.035 -0.468 -6.004 <0.001
血尿酸（umol/L） 0.004 0.009 0.03 0.436 0.664
24 h尿蛋白定量（g/24 h） 0.126 0.553 0.013 0.228 0.82
S1 2.701 1.606 0.097 1.681 0.095
C1+C2 3.612 1.604 0.13 2.251 0.026
图2 NLR预测IgA肾病患者中重度肾小管萎缩/间质纤维化的ROC曲线 注：NLR为中性粒细胞/淋巴细胞比；IgA为免疫球蛋白A
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