Evaluation value of systemic immune inflammation index for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease
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摘要:目的 探讨非透析的慢性肾脏病(CKD)患者左心室肥厚(LVH)的发生情况及相关危险因素, 分析全身免疫炎症指数(SII)对LVH的评估价值。方法 选取CKD患者196例为研究对象(CKD组),根据性别分为CKD男性组117例和CKD女性组79例,并选取同期40例健康者为对照组。收集并分析3组实验室指标及心脏超声资料。分析左心室质量指数(LVMI)与其他指标的相关性。采用Logistic回归分析LVH的危险因素,以及分析SII与LVH的关系。结果 男性、女性LVH患病率分别为31.62%、50.63%。收缩压(SBP)升高、血红蛋白(Hb)降低、SII升高是男性患者LVH发生的独立危险因素,而高龄、Hb降低、尿酸(UA)上升是女性患者LVH发生的独立危险因素(P<0.05)。结论 LVH在非透析的CKD患者中普遍存在,且女性患者较多。贫血是所有CKD患者LVH的危险因素, SII升高是男性患者LVH的危险因素。Abstract:Objective To investigate the incidence and risk factors of left ventricular hypertrophy (LVH) in non-dialysis patients with chronic kidney disease (CKD), and to analyze the value of systemic immune inflammation index (SII) in evaluating LVH.Methods A total of 196 non-dialysis patients with CKD were selected as study subjects (CKD group). According to gender, 196 cases were divided into male CKD group (n=117) and female CKD group (n=79), and 40 healthy subjects in the same period were selected as control group. The laboratory indexes and cardiac ultrasound data of three groups were collected and analyzed. The correlation between left ventricular mass index (LVMI) and other indexes was analyzed. Logistic regression was used to analyze the risk factors of LVH and the relationship between SII and LVH(P<0.05).Results The prevalence of LVH in male and female was 31.62% and 50.63%, respectively. Increased systolic blood pressure (SBP), decreased hemoglobin (Hb) and increased SII were independent risk factors for LVH in male patients, while older age, decreased Hb and increased uric acid (UA) were independent risk factors for LVH in female patients.Conclusion LVH is common in non-dialysis patients with CKD, and there are more female patients. Anemia is a risk factor for LVH in all CKD patients while SII is a risk factor for LVH in men.
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表 1 CKD组与对照组临床指标比较(x±s)[M(P25, P75)]
指标 CKD男性组(n=117) CKD女性组(n=79) 对照组(n=40) 年龄/岁 57.50(46.00, 66.00) 55.50(43.00, 67.50) 54.00(47.25, 63.00) 体质量指数/(kg/m2) 24.03(22.15, 27.16)# 22.68(20.79, 26.13) 22.98(21.22, 26.37) 收缩压/mmHg 139.50(129.75, 153.00)* 138.00(124.00, 153.50)* 124.50(115.00, 135.00) 舒张压/mmHg 81.93±10.42 78.70±11.67 79.30±12.78 平均动脉压/mmHg 101.72±10.10* 98.23±12.14 95.41±15.12 脉压/mmHg 57.75(47.00, 68.00)* 58.25(46.50, 68.75)* 45.50(40.00, 54.50) 中性粒细胞与淋巴细胞比值 2.83(1.95, 4.23)* 2.95(2.02, 4.56)* 1.71(1.37, 2.04) 淋巴细胞与单核细胞比值 2.87(2.26, 4.00)* 2.95(1.98, 4.27)* 4.77(3.85, 5.74) 血小板与淋巴细胞比值 113.23(89.84, 147.02) 116.35(93.69, 155.52) 111.05(85.49, 136.19) 全身免疫炎症指数/(×1012/L) 472.92(303.26, 663.45)* 430.50(309.39, 577.46)* 310.06(263.65, 404.09) 血红蛋白/(g/L) 121.50(96.00, 138.00)*# 108.00(87.00, 122.00)* 138.50(129.25, 153.25) 红细胞分布宽度/% 12.80(12.10, 13.40) 12.95(12.40, 13.60) 12.50(12.03, 13.20) 血小板/(×1012/L) 195.25±61.87 206.62±70.29 199.56±63.49 碱性磷酸酶/(U/L) 64.70(54.30, 82.30) 59.95(45.75, 85.10) 61.35(50.30, 71.68) 白蛋白/(g/L) 38.45(34.10, 41.70)* 38.45(34.5, 42.00)* 43.75(42.75, 46.48) 尿素氮/(mmol/L) 11.20(7.70, 22.80)* 12.30(5.90, 21.45)* 5.45(4.60, 6.18) 血清肌酐/(μmol/L) 201.00(129.30, 393.30)* 201.05(83.05, 383.00)* 62.00(52.98, 71.40) 尿酸/(μmol/L) 438.90(373.20, 519.50)*# 399.65(326.40, 491.15)* 337.70(275.73, 389.25) 血糖/(mmol/L) 4.88(4.39, 5.39) 4.84(4.41, 5.74) 4.89(4.49, 5.39) 总胆固醇/(mmol/L) 4.42(3.83, 5.15)# 4.94(4.275, 5.85) 4.80(4.29, 5.54) 甘油三酯/(mmol/L) 1.47(1.08, 2.24)* 1.51(1.15, 2.36)* 1.20(0.82, 1.44) 高密度脂蛋白胆固醇/(mmol/L) 0.97(0.79, 1.14)* 1.22(0.97, 1.45)* 1.26(1.06, 1.56) 低密度脂蛋白胆固醇/(mmol/L) 2.53(1.79, 3.33) 2.66(2.00, 3.31) 3.01(2.39, 3.38) 钙/(mmol/L) 2.21(2.11, 2.32) 2.21(2.13, 2.33) - 磷/(mmol/L) 1.25(1.06, 1.53) 1.35(1.20, 1.54) - 超敏C反应蛋白/(mg/L) 1.35(0.47, 2.95)* 0.98(0.35, 3.29)* 1.72(1.44, 2.84) eGFR/[mL/(min·1.73 m2)] 29.08(12.60, 52.05)* 23.65(11.14, 72.50)* 105.03(98.91, 118.54) eGFR: 估算肾小球滤过率。与对照组比较, *P<0.05; 与CKD女性组比较, #P<0.05。 表 2 CKD组与对照组心脏超声指标比较[M(P25, P75)][n(%)]
指标 CKD男性组(n=117) CKD女性组(n=79) 对照组(n=40) 左房内径/mm 38.00(35.00, 42.00)* 38.00(33.50, 41.50)* 34.00(32.00, 38.00) 室间隔厚度/mm 10.00(9.00, 11.00)*# 9.00(9.00, 10.00)* 9.00(8.00, 9.00) 左心室舒张末内径/mm 51.00(47.00, 54.00)*# 47.50(44.00, 51.00) 46.00(43.25, 49.00) 左室舒张期后壁厚度/mm 10.00(9.00, 10.00)* 9.00(8.50, 10.00)* 9.00(8.00, 9.75) 左心室质量/g 181.98(153.42, 213.18)*# 153.09(127.73, 175.61)* 135.79(109.44, 164.13) 左心室质量指数/(g/m2) 104.90(83.20, 120.84)* 95.87(84.23, 114.70)* 79.61(69.89, 95.13) 相对室壁厚度/mm 0.39(0.36, 0.42) 0.38(0.36, 0.41) 0.37(0.35, 0.40) EF值/% 65.00(61.00, 69.00)* 67.00(63.00, 69.00) 67.00(65.00, 69.00) 左心室肥厚 37(31.62) 40(50.63) - EF: 射血分数。与对照组比较, *P<0.05; 与CKD女性组比较, #P<0.05。 表 3 LVMI与临床指标的相关性分析
自变量 CKD男性组(n=117) CKD女性组(n=79) r P r P 年龄/岁 0.109 0.242 0.482 < 0.001 体质量指数/(kg/m2) 0.053 0.570 -0.074 0.516 收缩压/mmHg 0.411 < 0.001 0.366 0.001 舒张压/mmHg -0.130 0.163 -0.139 0.221 平均动脉压/mmHg 0.131 0.158 0.101 0.377 脉压/mmHg 0.477 < 0.001 0.509 < 0.001 中性粒细胞与淋巴细胞比值 -0.003 0.978 -0.093 0.415 淋巴细胞与单核细胞比值 0.086 0.357 0.129 0.258 血小板与淋巴细胞比值 0.277 0.002 0.024 0.834 全身免疫炎症指数/(×1012/L) 0.284 0.002 -0.050 0.659 血红蛋白/(g/L) -0.635 < 0.001 -0.625 < 0.001 红细胞分布宽度/% 0.373 < 0.001 0.318 0.004 血小板/(×1012/L) -0.106 0.255 -0.394 < 0.001 碱性磷酸酶/(U/L) 0.046 0.619 0.177 0.119 白蛋白/(g/L) -0.204 0.027 -0.083 0.469 尿素氮/(mmol/L) 0.537 < 0.001 0.576 < 0.001 血清肌酐/(μmol/L) 0.615 < 0.001 0.585 < 0.001 尿酸/(μmol/L) 0.007 0.944 0.413 < 0.001 血糖/(mmol/L) 0.030 0.748 -0.085 0.457 总胆固醇/(mmol/L) -0.264 0.004 -0.246 0.029 甘油三酯/(mmol/L) -0.097 0.299 0.108 0.342 高密度脂蛋白胆固醇/(mmol/L) -0.260 0.005 -0.336 0.002 低密度脂蛋白胆固醇/(mmol/L) -0.226 0.014 -0.330 0.003 钙/(mmol/L) -0.377 < 0.001 -0.257 0.022 磷/(mmol/L) 0.415 < 0.001 0.213 0.059 超敏C反应蛋白/(mg/L) -0.064 0.496 0.021 0.853 eGFR/[mL/(min·1.73 m2)] -0.398 < 0.001 -0.487 < 0.001 eGFR: 估算肾小球滤过率。 表 4 影响CKD男性组患者LVH的Logistic回归分析
自变量 单因素Logistic回归分析 多因素Logistic回归分析 OR(95%CI) P OR(95%CI) P 年龄/岁 1.010(0.984~1.036) 0.461 - - 体质量指数/(kg/m2) 1.063(0.946~1.194) 0.306 - - 收缩压/mmHg 1.056(1.025~1.087) < 0.001 1.033(1.001~1.066) 0.043 舒张压/mmHg 0.992(0.955~1.030) 0.662 - - 平均动脉压/mmHg 1.037(0.996~1.080) 0.079 - - 脉压/mmHg 1.057(1.028~1.087) < 0.001 - - 中性粒细胞与淋巴细胞比值 1.142(0.888~1.467) 0.300 - - 淋巴细胞与单核细胞比值 1.169(0.867~1.574) 0.305 - - 血小板与淋巴细胞比值 1.013(1.005~1.022) 0.003 - - 全身免疫炎症指数/(×1012/L) 1.002(1.001~1.004) 0.001 1.002(1.001~1.004) 0.009 血红蛋白/(g/L) 0.959(0.942~0.976) < 0.001 0.962(0.943~0.981) < 0.001 红细胞分布宽度/% 1.822(1.235~2.687) 0.003 - - 血小板/(×1012/L) 0.999(0.993~1.005) 0.744 - - 碱性磷酸酶/(U/L) 1.017(0.999~1.034) 0.066 - - 白蛋白/(g/L) 0.955(0.897~1.017) 0.151 - - 尿素氮/(mmol/L) 1.073(1.032~1.115) < 0.001 - - 血清肌酐/(μmol/L) 1.004(1.002~1.006) < 0.001 - - 尿酸/(μmol/L) 1.002(0.999~1.006) 0.223 - - 血糖/(mmol/L) 1.141(0.879~1.481) 0.320 - - 总胆固醇/(mmol/L) 0.669(0.461~0.970) 0.034 - - 甘油三酯/(mmol/L) 0.746(0.500~1.114) 0.152 - - 高密度脂蛋白胆固醇/(mmol/L) 0.179(0.039~0.821) 0.027 - - 低密度脂蛋白胆固醇/(mmol/L) 0.724(0.491~1.067) 0.103 - - 钙/(mmol/L) 0.005(0~0.100) 0.001 - - 磷/(mmol/L) 4.238(1.609~11.166) 0.003 - - 超敏C反应蛋白/(mg/L) 1.019(0.898~1.157) 0.769 - - eGFR/[mL/(min·1.73 m2)] 0.973(0.956~0.990) 0.002 - - eGFR: 估算肾小球滤过率。 表 5 影响CKD女性组患者LVH的Logistic回归分析
自变量 单因素Logistic回归分析 多因素Logistic回归分析 OR(95%CI) P OR(95%CI) P 年龄/岁 1.068(1.031~1.107) < 0.001 1.064(1.019~1.111) 0.005 体质量指数/(kg/m2) 1.005(0.909~1.111) 0.919 - - 收缩压/mmHg 1.032(1.006~1.059) 0.017 - - 舒张压/mmHg 0.970(0.932~1.009) 0.133 - - 平均动脉压/mmHg 1.006(0.970~1.043) 0.761 - - 脉压/mmHg 1.068(1.029~1.108) 0.001 - - 中性粒细胞与淋巴细胞比值 0.929(0.731~1.181) 0.548 - - 淋巴细胞与单核细胞比值 1.044(0.795~1.371) 0.756 - - 血小板与淋巴细胞比值 0.998(0.990~1.005) 0.543 - - 全身免疫炎症指数/(×1012/L) 1.000(0.999~1.001) 0.923 - - 血红蛋白/(g/L) 0.942(0.916~0.969) < 0.001 0.953(0.926~0.982) 0.002 红细胞分布宽度/% 1.593(1.041~2.439) 0.032 - - 血小板/(×1012/L) 0.986(0.977~0.994) 0.001 - - 碱性磷酸酶/(U/L) 1.013(0.995~1.032) 0.150 - - 白蛋白/(g/L) 0.999(0.938~1.064) 0.974 - - 尿素氮/(mmol/L) 1.095(1.036~1.157) 0.001 - - 血清肌酐/(μmol/L) 1.004(1.002~1.007) 0.001 - - 尿酸/(μmol/L) 1.006(1.002~1.011) 0.004 1.006(1.001~1.012) 0.031 血糖/(mmol/L) 0.735(0.507~1.064) 0.102 - - 总胆固醇/(mmol/L) 0.578(0.372~0.898) 0.015 - - 甘油三酯/(mmol/L) 0.957(0.664~1.380) 0.814 - - 高密度脂蛋白胆固醇/(mmol/L) 0.148(0.035~0.618) 0.009 - - 低密度脂蛋白胆固醇/(mmol/L) 0.457(0.262~0.795) 0.006 - - 钙/(mmol/L) 0.056(0.002~1.288) 0.072 - - 磷/(mmol/L) 4.108(0.965~7.482) 0.056 - - 超敏C反应蛋白/(mg/L) 1.027(0.916~1.152) 0.650 - - eGFR/(mL/min/1.73 m2) 0.970(0.954~0.986) < 0.001 - - eGFR: 估算肾小球滤过率。 -
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