Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ, USA.
CHU Poitiers Inserm, Clinical Investigation Center CIC1402, Poitiers, France.
Nephrol Dial Transplant. 2018 Jun 1;33(6):1001-1009. doi: 10.1093/ndt/gfx231.
Inflammation linked to diabetic kidney disease (DKD) may affect white blood cell (WBC) counts and differentials. We examined the cross-sectional associations of total WBC count and WBC fractions with structural lesions of DKD in 108 Pima Indians with Type 2 diabetes who underwent research kidney biopsies. We also examined the longitudinal association of these WBC variables with renal function loss (RFL) in 941 Europeans with Type 2 diabetes from the SURDIAGENE study.
Associations of WBC variables with morphometric parameters were assessed by linear regression. RFL was defined as≥40% loss of estimated glomerular filtration rate from baseline. Associations with RFL were evaluated by Cox regression. Hazard ratios (HRs) were reported per standard deviation increment of each WBC variable.
After multivariable adjustment, lymphocyte (r = -0.20, P = 0.043) and eosinophil (r = 0.21, P = 0.032) fractions in the Pima Indians correlated with glomerular basement membrane width. Eosinophil fraction also correlated with glomerular filtration surface density (r = -0.21, P = 0.031). Lymphocyte fraction (r = 0.25, P = 0.013), neutrophil fraction (r = -0.23, P = 0.021) and the neutrophil:lymphocyte ratio (r = -0.22, P = 0.024) correlated with percentage of normally fenestrated endothelial cells. During median follow-up of 4.5 years, 321 SURDIAGENE participants developed RFL. Lower lymphocyte fraction [HR = 0.67, 95% confidence interval (95% CI) 0.60-0.76] and higher neutrophil fraction (HR = 1.35, 95% CI 1.20-1.52), total WBC count (HR = 1.20, 95% CI 1.08-1.35) and neutrophil:lymphocyte ratio (HR = 1.44, 95% CI 1.28-1.62) each predicted RFL in this cohort.
WBC fractions associate with morphometric lesions of DKD and predict RFL in individuals with Type 2 diabetes.
与糖尿病肾病（DKD）相关的炎症可能会影响白细胞（WBC）计数和分类。我们在 108 名接受研究性肾脏活检的 2 型糖尿病皮马印第安人中检查了总 WBC 计数和 WBC 分数与 DKD 结构病变的横断面关联。我们还检查了这些 WBC 变量与来自 SURDIAGENE 研究的 941 名 2 型糖尿病欧洲人肾功能丧失（RFL）的纵向关联。
通过线性回归评估 WBC 变量与形态计量参数的关联。RFL 定义为基线时估计肾小球滤过率损失≥40%。通过 Cox 回归评估与 RFL 的关联。报告每个 WBC 变量的标准偏差增量的风险比（HR）。
在多变量调整后，皮马印第安人的淋巴细胞（r = -0.20，P = 0.043）和嗜酸性粒细胞（r = 0.21，P = 0.032）分数与肾小球基底膜宽度相关。嗜酸性粒细胞分数也与肾小球滤过表面积密度相关（r = -0.21，P = 0.031）。淋巴细胞分数（r = 0.25，P = 0.013）、中性粒细胞分数（r = -0.23，P = 0.021）和中性粒细胞：淋巴细胞比值（r = -0.22，P = 0.024）与正常有孔内皮细胞的百分比相关。在中位数为 4.5 年的随访期间，321 名 SURDIAGENE 参与者发生了 RFL。较低的淋巴细胞分数[HR = 0.67，95%置信区间（95%CI）0.60-0.76]和较高的中性粒细胞分数（HR = 1.35，95%CI 1.20-1.52）、总 WBC 计数（HR = 1.20，95%CI 1.08-1.35）和中性粒细胞：淋巴细胞比值（HR = 1.44，95%CI 1.28-1.62）均预测该队列中的 RFL。
WBC 分数与 2 型糖尿病患者的 DKD 形态计量病变相关，并预测 RFL。
