Shiny Abhijit, Bibin Yesodha S, Shanthirani Coimbatore Subramanian, Regin Bhaskaran S, Anjana Ranjit Mohan, Balasubramanyam Muthuswamy, Jebarani Saravanan, Mohan Viswanathan
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre , WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and International Diabetes Federation Centre of Education, Gopalapuram, Chennai, India .
Diabetes Technol Ther. 2014 Aug;16(8):524-30. doi: 10.1089/dia.2013.0264. Epub 2014 Jan 23.
The neutrophil-lymphocyte ratio (NLR) has been demonstrated to be a better risk factor than total white blood cell count in the prediction of adverse outcomes in various medical conditions. This study analyzed the association of NLR with different grades of glucose tolerance and insulin resistance in Asian Indians.
Study subjects were recruited from Phase 3 of the Chennai Urban Rural Epidemiology Study (CURES). For this cross-sectional analysis, subjects with normal glucose tolerance (NGT) (n=237), impaired glucose tolerance (IGT) (n=63), and type 2 diabetes mellitus (DM) (n=286) were selected. The hemogram was done in all subjects using a five-part hematology analyzer (model SF-3000; Sysmex, Kobe, Japan). The NLR was calculated as the ratio between counts for neutrophils and total lymphocytes. Fasting insulin was measured by enzyme-linked immunosorbent assay, and insulin resistance was calculated using the homeostasis model assessment (HOMA-IR).
Subjects with DM showed a significantly higher NLR (2.2 ± 1.12) compared with IGT subjects (1.82 ± 0.63), who in turn had a higher ratio than NGT subjects (1.5 ± 0.41) (P<0.01). Pearson correlation analysis showed a significant positive correlation of NLR with glycated hemoglobin (r=0.411), fasting plasma glucose (r=0.378), and HOMA-IR (r=0.233) (P<0.001). Regression analysis showed a linear increase in NLR with increasing severity of glucose intolerance even after adjusting for age, waist circumference, blood pressure, triglycerides, and smoking.
This is the first report on the correlation of NLR with different grades of glucose intolerance and insulin resistance. NLR can be used as an adjuvant prognostic marker for macro- and microvascular complications in patients with glucose intolerance.
在各种医疗状况下，中性粒细胞与淋巴细胞比值（NLR）已被证明在预测不良结局方面是比白细胞总数更好的风险因素。本研究分析了亚洲印度人中NLR与不同程度糖耐量和胰岛素抵抗之间的关联。
研究对象来自金奈城乡流行病学研究（CURES）的第3阶段。对于本次横断面分析，选取了糖耐量正常（NGT）（n = 237）、糖耐量受损（IGT）（n = 63）和2型糖尿病（DM）（n = 286）的受试者。所有受试者均使用五分类血液分析仪（型号SF - 3000；日本神户希森美康公司）进行血常规检查。NLR计算为中性粒细胞计数与淋巴细胞总数之比。空腹胰岛素通过酶联免疫吸附测定法测量，胰岛素抵抗采用稳态模型评估（HOMA - IR）计算。
与IGT受试者（1.82±0.63）相比，DM受试者的NLR显著更高（2.2±1.12），而IGT受试者的比值又高于NGT受试者（1.5±0.41）（P<0.01）。Pearson相关分析显示，NLR与糖化血红蛋白（r = 0.411）、空腹血糖（r = 0.378）和HOMA - IR（r = 0.233）呈显著正相关（P<0.001）。回归分析显示，即使在调整年龄、腰围、血压、甘油三酯和吸烟因素后，随着糖耐量异常严重程度的增加，NLR呈线性升高。
这是关于NLR与不同程度糖耐量异常和胰岛素抵抗相关性的首份报告。NLR可作为糖耐量异常患者大血管和微血管并发症的辅助预后标志物。
