目的 探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对2型糖尿病(type 2 diabetes mellitus, T2DM)患者微量白蛋白尿的预测价值。方法 回顾性分析2020年11月至2021年6月河北省人民医院内分泌科收治的T2DM住院患者400例。根据24 h尿微量白蛋白检测结果分组,24 h尿微量白蛋白<30 mg为正常组(n=236), 30 mg≤24 h尿微量白蛋白<300 mg为微量白蛋白尿组(n=164),比较两组一般资料及实验室检查结果。采用二分类Logistic回归分析探究T2DM患者微量白蛋白尿的影响因素,通过绘制受试者工作特征(receiver operating characteristic, ROC)曲线,评估NLR及联合诊断对T2DM患者微量白蛋白尿的预测价值。结果 微量白蛋白尿组年龄及高血压患者占比、白细胞(white blood cell, WBC)计数、中性粒细胞(absolute neutrophil, NEU)计数、NLR、甘油三酯(triacylglycerol, TG)、肌酐(creatinine, Scr)、尿素氮(urea nitrogen, BUN)高于正常组,估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)低于正常组, 差异有统计学意义(均P<0.05)。NLR单独预测T2DM患者微量白蛋白尿的ROC曲线下面积(area under the curve, AUC)为0.644[95%CI(0.586,0.701)],最佳截断值为2.81,灵敏度为46.1%,特异度为85.8%。NLR联合BUN、eGFR、TG、是否合并高血压的AUC为0.727[95%CI(0.678,0.777)],最佳截断值为0.426,灵敏度为59.9%,特异度为74.2%。结论 NLR可作为预测T2DM患者微量白蛋白尿的临床指标之一。

Objective To determine the predictive value of neutrophil to lymphocyte ratio (NLR) for microalbuminuria of type 2 diabetes mellitus (T2DM). Methods A retrospective analysis was performed on 400 T2DM inpatients admitted to the Department of Endocrinology, Hebei General Hospital from November 2020 to June 2021. Using the results of 24 hour urinary microalbumin, the patients were assigned to the normal group (n=236, 24 hour urinary microalbumin<30 mg) and the microalbuminuria group (n=164, 30 mg≤24 hour urinary microalbumin<300 mg). The general data and laboratory results were compared between two groups, binary Logistic regression analysis was conducted to assess the influencing factors for microalbuminuria in T2DM patients. The predictive value of NLR and combined diagnosis on microalbuminuria in T2DM patients was evaluated by drawing receiver operating characteristic (ROC) curve. Results The percentage of patients with advanced age and hypertension, white blood cell (WBC) count, neutrophils absolute (NEU) count, NLR, triglyceride (TG), serum creatinine (Scr) and urea nitrogen (BUN) were higher in microalbuminuria group than the normal group, but the estimated glomerular filtration rate (eGFR) and high density lipoprotein cholesterol (HDL-C) were significantly lower than that in the normal group (all P<0.05). The area under the curve (AUC) of NLR alone for predicting microalbuminuria of T2DM patients was 0.644[95%CI(0.586, 0.701)], the best cutoff value for 2.81, the sensitivity for 46.1%, and the specificity for 85.8%. The AUC obtained by NLR combined with BUN, eGFR, TG, and whether hypertension was 0.727[95%CI (0.678, 0.777)], the optimal cutoff of 0.426, the sensitivity of 59.9%, and the specificity of 74.2%.Conclusion NLR can be used as one of the clinical indicators to predict microalbuminuria of T2DM patients.