中性粒细胞与淋巴细胞比值与尿毒症毒素吲哚硫酸酯相关，并可预测血液透析患者的死亡风险。
Neutrophil:lymphocyte ratio correlates with the uremic toxin indoxyl sulfate and predicts the risk of death in patients on hemodialysis.
机构信息
Aix Marseille Université, INSERM, INRAE, C2VN, Marseille, France.
Centre de néphrologie et transplantation rénale, Hôpital de la conception AP-HM, Marseille, France.
出版信息
Nephrol Dial Transplant. 2022 Nov 23;37(12):2528-2537. doi: 10.1093/ndt/gfab350.
BACKGROUND
Chronic kidney disease (CKD) is a major public health issue associated with increased cardiovascular, infectious and all-cause mortality. The neutrophil:lymphocyte ratio (NLR) is a predictive marker of the risk of death and cardiovascular events. Uremic toxins, notably indoxyl sulfate (IS), are involved in immune deficiency and cardiovascular complications associated with CKD. The aim of this study was to assess whether the NLR was related to uremic toxins and could predict clinical outcome in hemodialysis (HD) patients.
METHODS
We conducted a prospective cohort study of 183 patients on chronic HD. The main objective was to study the correlation between the NLR and uremic toxin serum levels. The secondary objective was to test if the NLR can predict the incidence of mortality, cardiovascular events and infectious events.
RESULTS
Patients were separated into two groups according to the NLR median value (3.49). The NLR at inclusion was correlated with the NLR at the 6-month (r = 0.55, P < 0.0001) and 12-month (r = 0.62, P < 0.0001) follow-up. Among uremic toxins, IS levels were higher in the group with high NLR (104 µmol/L versus 81 µmol/L; P = 0.004). In multivariate analysis, the NLR remained correlated with IS (P = 0.03). The incidence of death, cardiovascular events and severe infectious events was higher in the group with high NLR [respectively, 38% versus 18% (P = 0.004), 45% versus 26% (P = 0.01) and 33% versus 21% (P = 0.02)] than in the low NLR group. Multivariate analysis showed an independent association of the NLR with mortality (P = 0.02) and cardiovascular events (P = 0.03) but not with severe infectious events.
CONCLUSIONS
In HD patients, the NLR predicted mortality and cardiovascular events but not severe infections and correlated positively with the level of the uremic toxin IS. The NLR could be an interesting marker for monitoring the risk of clinical events in CKD patients.
背景
慢性肾脏病（CKD）是与心血管疾病、感染和全因死亡率增加相关的主要公共卫生问题。中性粒细胞与淋巴细胞比值（NLR）是死亡和心血管事件风险的预测指标。尿毒症毒素，特别是硫酸吲哚酚（IS），与 CKD 相关的免疫缺陷和心血管并发症有关。本研究旨在评估 NLR 是否与尿毒症毒素有关，并能预测血液透析（HD）患者的临床结局。
方法
我们对 183 名慢性 HD 患者进行了前瞻性队列研究。主要目的是研究 NLR 与尿毒症毒素血清水平之间的相关性。次要目的是测试 NLR 是否可以预测死亡率、心血管事件和感染事件的发生率。
结果
根据 NLR 中位数（3.49）将患者分为两组。纳入时的 NLR 与 6 个月（r=0.55，P<0.0001）和 12 个月（r=0.62，P<0.0001）随访时的 NLR 相关。在尿毒症毒素中，高 NLR 组的 IS 水平较高（104µmol/L 比 81µmol/L；P=0.004）。多变量分析中，NLR 仍与 IS 相关（P=0.03）。高 NLR 组的死亡率、心血管事件和严重感染事件发生率较高[分别为 38%比 18%（P=0.004）、45%比 26%（P=0.01）和 33%比 21%（P=0.02）]，低于低 NLR 组。多变量分析显示 NLR 与死亡率（P=0.02）和心血管事件（P=0.03）独立相关，但与严重感染事件无关。
结论
在 HD 患者中，NLR 预测死亡率和心血管事件，但不能预测严重感染，且与尿毒症毒素 IS 水平呈正相关。NLR 可能是监测 CKD 患者临床事件风险的一个有价值的标志物。
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