Neutrophil-to-lymphocyte ratio as an independent inflammatory indicator of poor prognosis in IgA nephropathy
Neutrophil-to-lymphocyte ratio as an independent inflammatory indicator of poor prognosis in IgA nephropathy
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DOI：
10.1016/j.intimp.2020.106811
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发表时间：
2020-10-01
影响因子：
5.6
通讯作者：
Zhang, Hong
中科院分区：
文献类型：
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作者：
Li, Qianqian;Chen, Ping;Zhang, Hong
背景：IgA肾病(IgAN)是一种慢性免疫炎症性进行性疾病。一些全身性炎症指标，主要是中性粒细胞/淋巴细胞比率(NLR)，被认为是许多疾病的有价值的标志物，如IgA血管炎和慢性肾脏疾病。在这里，我们调查了一个大型IgAN登记处的多项外周血液指标，并进行了定期随访，以评估它们对IgAN表型和进展的影响。方法：共有1151例定期随访的IgAN患者和251名健康志愿者入选。从病历中收集完整的血细胞计数结果，包括白细胞(WBC)、中性粒细胞(NE)、淋巴细胞(LY)和血小板(PLT)的计数。结果：IGAN患者WBC、NE、NLR、PLR水平明显高于对照组，LY水平明显低于对照组。单因素生存分析显示，WBC、NE和NLR与IgAN的进展显著相关，且NLR的ROC曲线下面积高于NE和WBC。在对众所周知的危险因素进行调整后，NLR仍然是IgAN患者肾脏预后不良的独立危险因素，并且表现优于NE。以NLR2.40为界点，将IgA肾病患者分为两组。高NLR组IGAN患者EGFR降低，蛋白尿增多，高血压发生率高，病理损害重，无事件肾存活率低。结论：我们发现IGAN患者NLR水平高于健康对照组，临床上易获得的NLR可作为IGAN进展的独立危险因素。
Background: IgA nephropathy (IgAN) is a chronic immuno-inflammatory progressive disease. Several systemic inflammatory indicators, mainly the neutrophil-to-lymphocyte ratio (NLR), are regarded as valuable markers for many diseases, such as IgA vasculitis and chronic kidney disease. Here, we investigated multiple peripheral blood indicators in a large IgAN registry with regular follow-up to evaluate their effects on IgAN phenotypes and progression.Methods: Totally, 1151 IgAN patients with regular follow-up, and 251 healthy volunteers were enrolled. Complete blood count test results, including counts of white blood cells (WBC), neutrophils (NE), lymphocyte (LY), and platelets (PLT), were collected from medical records. Then, NLR and PLR were calculated.Results: IgAN patients presented with increased WBC, NE, NLR and PLR levels and decreased LY levels compared with controls. In univariate survival analysis, WBC, NE and NLR showed significant associations with IgAN progression, and NLR had a higher area under the ROC curves than NE and WBC. When adjusted for well-known risk factors, NLR remained an independent risk factor for poor renal outcome in IgAN patients and performed better than NE. By using NLR 2.40 as cutoff point, IgAN patients were divided into two groups. IgAN patients in the high NLR group presented with lower eGFR, higher proteinuria, higher incidence of hypertension, and more severe pathological lesions, as well as lower event-free renal survival rate.Conclusions: We found patients with IgAN had elevated NLR levels than healthy controls, and the easily available NLR in clinical practice could serve as an independent risk factor for IgAN progression.