[中性粒细胞与淋巴细胞比值对急性肾损伤预测作用的Meta分析]
[A Meta-analysis of the predictive effect of neutrophil-lymphocyte ratio on acute kidney injury].
作者信息
Lu Zhi, Wang Lihua, Jia Lan, Wei Fang, Jiang Aili
机构信息
Department of Kidney Diseaseand Blood Purification, the Second Hospital of Tianjin Medical University, Tianjin 300211, China. Corresponding author: Wang Lihua, Email:
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Mar;33(3):311-317. doi: 10.3760/cma.j.cn121430-20201215-00755.
OBJECTIVE
To systematically evaluate the predictive value of neutrophil-lymphocyte ratio (NLR) in acute kidney injury (AKI).
METHODS
All studies about the predictive effect of NLR on AKI were searched in the National Medical Library of the United States PubMed Database, the Embase database in the Netherlands, the Chinese Biology Medicine disc (CBMdisc) and the Chinese Evidence Based Medicine Cochrane Centre Database (CEBM/CCD). The data updated by October 2020, and regardless of language, region or whether blind method was used. Two authors independently extracted data and evaluated the quality of the studies. Data extracted from the studies were analyzed with RevMan 5.3 to assess the predictive value of NLR on AKI. A subgroup Meta-analysis was conducted to assess the predictive value of NLR on AKI according to different countries, different disease types (cardiovascular surgery, infectious diseases, other diseases including burns, cirrhosis, and emergency), and different sample sizes (≤ 300 cases and > 300 cases). The publication bias of included studies about the predictive effect of NLR on AKI were assessed by funnel plots.
RESULTS
A total of 11 studies were included in this Meta-analysis, including 4 997 patients, 1 308 patients in AKI group, and 3 689 patients in non-AKI group. The Meta-analysis results showed that: increased NLR had predictive value for the occurrence of AKI [mean difference (MD) = 2.73, 95% confidence interval (95%CI) was 1.78-3.68, P < 0.000 01]. Subgroup analysis showed that increased NLR had predictive value for the occurrence of AKI in patients from Southeast Asia (MD = 4.04, 95%CI was 1.09-6.99, P = 0.007) and Eurasia (MD = 2.51, 95%CI was 1.12-3.90, P = 0.000 4). Increased NLR had predictive value for the occurrence of AKI in patients undergoing cardiovascular surgery (MD = 0.77, 95%CI was 0.34-1.20, P = 0.000 4), infectious diseases (MD = 4.74, 95%CI was 1.51-7.96, P = 0.004) and other diseases (MD = 8.53, 95%CI was 6.26-10.80, P < 0.000 01). Increased NLR had predictive value for the occurrence of AKI in studies with a sample size of ≤ 300 cases (MD = 6.02, 95%CI was 4.90-7.14, P < 0.000 01) and > 300 cases (MD = 1.32, 95%CI was 0.61-2.03, P = 0.000 3). There was no significant publication bias in the included studies assessed by funnel plots.
CONCLUSIONS
NLR is an important predictive tool for AKI.
目的
系统评价中性粒细胞与淋巴细胞比值（NLR）对急性肾损伤（AKI）的预测价值。
方法
检索美国国立医学图书馆PubMed数据库、荷兰Embase数据库、中国生物医学光盘数据库（CBMdisc）及中国循证医学Cochrane中心数据库（CEBM/CCD）中所有关于NLR对AKI预测作用的研究。检索截至2020年10月的数据，不限语言、地区及是否采用盲法。由两位作者独立提取数据并评估研究质量。采用RevMan 5.3软件对纳入研究的数据进行分析，以评估NLR对AKI的预测价值。根据不同国家、不同疾病类型（心血管手术、传染病、包括烧伤、肝硬化及急诊在内的其他疾病）及不同样本量（≤300例和>300例）进行亚组Meta分析，评估NLR对AKI的预测价值。采用漏斗图评估纳入研究中关于NLR对AKI预测作用的发表偏倚。
结果
本Meta分析共纳入11项研究，包括4997例患者，其中AKI组1308例，非AKI组3689例。Meta分析结果显示：NLR升高对AKI的发生具有预测价值[平均差（MD）=2.73，95%置信区间（95%CI）为1.78 - 3.68，P<0.00001]。亚组分析显示，NLR升高对东南亚患者（MD = 4.04，95%CI为1.09 - 6.99，P = 0.007）及欧亚地区患者（MD = 2.51，95%CI为1.12 - 3.90，P = 0.0004）AKI的发生具有预测价值。NLR升高对接受心血管手术患者（MD = 0.77，95%CI为0.34 - 1.20，P = 0.0004）、传染病患者（MD = 4.74，95%CI为1.51 - 7.96，P = 0.004）及其他疾病患者（MD = 8.53，95%CI为6.26 - 10.80，P<0.00001）AKI的发生具有预测价值。NLR升高对样本量≤300例（MD = 6.02，95%CI为4.90 - 7.14，P<0.00001）及>300例（MD = 1.32，95%CI为0.61 - 2.03，P = 0.0003）研究中AKI的发生具有预测价值。漏斗图评估纳入研究未发现明显的发表偏倚。
结论
NLR是AKI的重要预测工具。
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