单核细胞/高密度脂蛋白比值对维持性血液透析患者全因死亡的预测价值

张少青; 黄岚; 董海霞; 朱燕

doi:10.3969/j.issn.1671-2390.2024.04.002

单核细胞/高密度脂蛋白比值对维持性血液透析患者全因死亡的预测价值

Predictive value of monocyte-to-high-density lipoprotein ratio for all-cause mortality in maintenance hemodialysis patients

摘要

摘要:
目的探讨单核细胞/高密度脂蛋白（high density lipoprotein，HDL）比值（monocyte-to-high density lipoprotein ratio，MHR）对维持性血液透析（maintenance hemodialysis，MHD）患者全因死亡的预测价值。
方法选取2014年11月至2020年11月南京市中心医院血液净化中心收治的MHD患者100例，随访至研究终点，死亡24例、生存76例，比较死亡组和生存组患者的一般情况、各实验室指标、MHR、中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、单核细胞/淋巴细胞比值（monocyte-to-lymphocyte ratio，MLR）、血小板/淋巴细胞比值、C反应蛋白（C-reactive protein，CRP）/白蛋白比值（C-reactive protein-to-albumin ratio，CAR）的差异。采用Logistic回归分析MHD患者死亡的影响因素。根据MHR中位数将患者分为高MHR组（n = 50）和低MHR组（n = 50），采用Kaplan-Meier法进行生存分析。采用受试者工作特征（receiver operating characteristic，ROC）曲线评估相关指标对MHD患者全因死亡的预测价值。
结果死亡组患者年龄77.00（71.25，85.75）岁比64.00（52.25，73.75）岁大于生存组（P＜0.05）；死亡组患者合并糖尿病比例（54.17%比28.95%）、NLR5.059（2.959，5.961）比3.582（2.746，4.468）、MLR0.391（0.300，0.493）比0.317（0.227，0.411）、CRP5.475（2.368，7.350）mg/L比2.410（1.025，5.475）mg/L、CAR0.142（0.062，0.208）mg/g比0.061（0.027，0.144）mg/g、MHR0.457（0.340，0.598）比0.328（0.241，0.454）高于生存组（P＜0.05），HDL0.840（0.725，1.018）mmol/L比1.010（0.813，1.280）mmol/L低于生存组（P＜0.05）。Logistic回归分析提示年龄和MHR是MHD患者全因死亡的危险因素。高MHR组患者总体生存率低于低MHR组（χ² = 6.657，P＜0.05）。ROC曲线结果提示MHR、CAR、NLR、MLR以及四者联合均对MHD患者具有预测价值，AUC分别为0.694、0.691、0.650、0.647、0.740（P均＜0.05）。
结论 MHR对MHD患者全因死亡具有临床预测价值。

Abstract:
Objective To explore the predictive value of monocyte-to-high-density lipoprotein (HDL) ratio (MHR) for all-cause mortality in maintenance hemodialysis (MHD) patients.
Methods From November 2014 to November 2020, 100 MHD patients admitted into Blood Purification Center were recruited. At the end of the study, 24 patients died and 76 survived. The inter-group differences of general profiles, laboratory parameters, MHR, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP)-to-albumin ratio (CAR) were compared. The influencing factors of death were analyzed by Logistics regression. Based upon the level of median MHR, they were divided into two groups of high MHR (n=50) and low MHR (n=50). Survival analysis was conducted by the Kaplan-Meier method. Receiver operating characteristic (ROC) curve was plotted for assessing the predictive values of the relevant parameters for all-cause death.
Results Patients were older in death group than those in survival group 77.00(71.25, 85.75) years vs 64.00(52.25, 73.75) years, P<0.05. The proportion of patients with diabetes (54.17% vs 28.95%) and levels of NLR 5.059(2.959, 5.961) vs 3.582(2.746, 4.468), MLR 0.391(0.300, 0.493) vs 0.317(0.227, 0.411), CRP 5.475(2.368, 7.350) mg/L vs 2.410(1.025, 5.475) mg/L, CAR 0.142(0.062, 0.208) mg/g vs 0.061(0.027, 0.144) mg/g and MHR 0.457(0.340, 0.598) vs 0.328(0.241, 0.454) were higher in death group than those in survival group (P<0.05). The level of HDL was lower in death group than that in survival group 0.840(0.725, 1.018) mmol/L vs 1.010(0.813, 1.280) mmol/L, P<0.05. Logistic regression analysis indicated that age and MHR were risk factors for all-cause mortality. Overall survival rate was lower in high MHR group than that in low MHR group (χ²=6.657, P<0.05). ROC curve implied that MHR, CAR, NLR, MLR and their combinations had predictive values for MHD patients. Area under curve (AUC) was 0.694, 0.691, 0.650, 0.647 and 0.740 respectively (P<0.05）.
Conclusions MHR has clinical predictive value for all-cause mortality in MHD patients.

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