单核细胞/淋巴细胞比值与腹膜透析患者心血管疾病死亡率的关系。
Monocyte/Lymphocyte Ratio and Cardiovascular Disease Mortality in Peritoneal Dialysis Patients.
机构信息
Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
出版信息
Mediators Inflamm. 2020 Feb 14;2020:9852507. doi: 10.1155/2020/9852507. eCollection 2020.
OBJECTIVES
The monocyte-to-lymphocyte ratio (MLR), as a new marker of the systemic inflammatory response, is associated with cardiovascular disease (CVD) mortality in the general population and hemodialysis patients. However, the association between the MLR and CVD mortality in peritoneal dialysis (PD) has received little attention.
METHODS
In this multicenter retrospective cohort study, 1753 incident PD patients from November 1, 2005, to June 30, 2017, with a baseline MLR were enrolled. The primary endpoint was CVD mortality. The association of MLR with CVD mortality was assessed using a multivariable-adjusted Cox model and the Fine and Gray competing risk model.
RESULTS
Of 1753 patients, the mean age was 51.1 ± 14.9 years, 56.9% of patients were male, and the Charlson comorbidity index was 4.29 ± 1.75. During the follow-up period of 31.2 ± 18.4 months, 368 patients died, of which 200 (54.3%) deaths were caused by CVD events. CVD mortality rates for the lowest, middle, and highest MLR tertiles were 70.6, 78.4, and 88.9 per 1000 patient-years, respectively ( < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, < 0.001). Kaplan-Meier analysis revealed that survival rates were significantly different among the three MLR groups (log rank = 22.41, < 0.001). After adjusting for confounding factors, the highest MLR tertile was significantly associated with a hazard ratio (HR) for CVD mortality of 1.45 (95% confidence interval, 1.13-2.51, = 0.016). The Fine and Gray method analysis showed that using all-cause mortality as competing risk, the highest MLR tertile remained an independent predictor of CVD mortality (HR = 1.39, 95% CI 1.10-2.47, = 0.021).
CONCLUSIONS
Higher MLR levels at the commencement of PD may be independently associated with increased CVD mortality in PD patients.
目的
单核细胞与淋巴细胞比值（MLR）作为全身炎症反应的新标志物，与普通人群和血液透析患者的心血管疾病（CVD）死亡率相关。然而，MLR 与腹膜透析（PD）患者 CVD 死亡率之间的关联尚未得到充分关注。
方法
在这项多中心回顾性队列研究中，纳入了 1753 例于 2005 年 11 月 1 日至 2017 年 6 月 30 日期间基线 MLR 的首发 PD 患者。主要终点为 CVD 死亡率。使用多变量调整 Cox 模型和 Fine 和 Gray 竞争风险模型评估 MLR 与 CVD 死亡率的关系。
结果
在 1753 例患者中，平均年龄为 51.1 ± 14.9 岁，56.9%的患者为男性，Charlson 合并症指数为 4.29 ± 1.75。在 31.2 ± 18.4 个月的随访期间，有 368 例患者死亡，其中 200 例（54.3%）死亡由 CVD 事件引起。最低、中、最高 MLR 三分位组的 CVD 死亡率分别为 70.6、78.4 和 88.9/1000 患者-年（<0.001）。Kaplan-Meier 分析显示，三组 MLR 之间的生存率差异具有统计学意义（log-rank = 22.41，<0.001）。Kaplan-Meier 分析显示，三组 MLR 之间的生存率差异具有统计学意义（log-rank = 22.41，<0.001）。Kaplan-Meier 分析显示，三组 MLR 之间的生存率差异具有统计学意义（log-rank = 22.41，<0.001）。Kaplan-Meier 分析显示，三组 MLR 之间的生存率差异具有统计学意义（log-rank = 22.41，<0.001）。在调整混杂因素后，最高 MLR 三分位组与 CVD 死亡率的风险比（HR）为 1.45（95%置信区间，1.13-2.51，=0.016）显著相关。Fine 和 Gray 方法分析显示，以全因死亡率为竞争风险时，最高 MLR 三分位组仍是 CVD 死亡率的独立预测因子（HR = 1.39，95%CI 1.10-2.47，=0.021）。
结论
PD 起始时较高的 MLR 水平可能与 PD 患者 CVD 死亡率的增加独立相关。
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