摘要
目的透析充分性是影响维持性血液透析(MHD)患者预后的重要因素。本文旨在探讨影响MHD患者透析充分性的危险因素及中性粒细胞/淋巴细胞比值(NLR)与透析充分性的关系,同时分析其对透析不充分的预测价值。方法选取2020年9月至2021年9月在昆明医科大学第一附属医院血液净化中心治疗的MHD患者。收集患者的一般临床资料及实验室检查结果,根据患者尿素清除指数(Kt/V)≥1.2和尿素下降率(URR)≥65%将患者分为透析充分组和透析不充分组。比较两组间各指标的差异,采用二元Logistic回归分析法探讨透析不充分发生的危险因素,并采用受试者工作特征(ROC)曲线判断NLR对透析不充分的预测价值。结果共纳入120例MHD患者,透析充分组71例,非透析充分组49例。与透析充分组相比,非透析充分组男性患者占比、身体质量指数(BMI)、NLR值、中性粒细胞数均明显升高,HDL降低。Logistic回归分析发现:男性(OR2.970,95%CI:1.211~7.283,P=0.017)、高BMI(OR1.361,95%CI:1.161~1.595,P<0.001)、高NLR(OR1.310,95%CI:1.023~1.677,P=0.032)为透析不充分的危险因素,NLR预测MHD患者透析不充分的ROC曲线下面积(AUC)为0.635(P<0.05)。结论男性、高BMI及NLR是透析不充分的独立危险因素,NLR对透析不充分具有良好的预测价值,有望作为判断MHD患者预后的指标。
Objective Dialysis adequacy is an important factor affecting the prognosis of maintenance hemodialysis(MHD)patients.The purpose of this study was to explore the risk factors affecting dialysis adequacy and the relationship between neutrophil-to-lymphocyte ratio(NLR)and dialysis adequacy in patients with MHD,and to analyze its predictive value for inadequate dialysis.MethodsPatients with MHD who were treated in the blood purification center of our hospital from September 2020 to September 2021 were selected.The general clinical data and laboratory examination results of the patients were collected.The patients were divided into adequate dialysis group and inadequate dialysis group according to the urea clearance index(Kt/V)≥1.2 and urea reduction rate(URR)≥65%.The differences of each index between the two groups were compared.The risk factors of inadequate dialysis were discussed by the binary logistic regression analysis method.The receiver operating characteristic(ROC)curve was used to judge the predictive value of NLR for inadequate dialysis.ResultsA total of 120 MHD patients were included with 71 patients in the adequate dialysis group and 49 patients in the inadequate dialysis group.Compared with the adequate dialysis group,the proportion of male patients,body mass index(BMI),NLR,and the neutrophils count were all significantly higher while high density lipoprotein(HDL)was lower in the inadequate dialysis group.Logistic regression analysis showed that male(OR2.970,95%CI:1.211-7.283,P=0.017),BMI(OR1.361,95%CI:1.161-1.595,P<0.001),and NLR(OR1.310,95%CI:1.023-1.677,P=0.032)were risk factors for inadequate dialysis,and that the area under curve(AUC)of NLR for predicting inadequate dialysis in MHD patients was 0.635(P<0.05).ConclusionMale,higher BMI,and higher NLR were independent risk factors for inadequate dialysis.NLR had good predictive value for inadequate dialysis and was expected to be used as an index to judge the prognosis of patients with MHD.
作者
葛杰
Mali Niroj
陈广梅
樊文星
何佳敏
曹玲艳
Jie Ge;Mali Niroj;Guangmei Chen;Wenxing Fan;Jiamin He;Lingyan Cao(Department of Nephrology,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China;Department of Medical Records,First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan Province,China)
出处
《中华肾病研究电子杂志》
2022年第6期327-331,共5页
Chinese Journal of Kidney Disease Investigation（Electronic Edition）
基金
国家自然科学基金地区基金项目(82160142)
云南省科技厅-昆明医科大学应用基础研究联合专项资金项目杰出青年培育项目(202201AY070001-044)
云南省卫生健康委员会医学学科带头人培养项目(D-2018027)
