目的 探讨中性粒细胞与淋巴细胞比值(neutrophil/lymphocyte ratio，NLR)、血小板与淋巴细胞比值(platelet/lymphocyte ratio，PLR)、脂蛋白相关磷脂酶A2(lipoprotein phospholipase A2，Lp-PLA2)在维持性血液透析(maintenance hemodialysis，MHD)患者蛋白质能量消耗(protein energy wasting，PEW)的联合诊断价值。 方法 收集泰州市人民医院327例接受MHD治疗患者临床资料，根据国际肾脏营养和代谢学会(international society of renal nutrition and metabolism，ISRNM)诊断标准，将MHD患者分为PEW组和非PEW组。探索NLR、PLR、Lp-PLA2在MHD患者PEW诊断中的应用价值。 结果 327例患者中有101例患者发生PEW，发生率为31%。PEW组患者体质量指数(body mass index，BMI)、白蛋白、前白蛋白、总胆固醇、肌酐、尿酸水平均低于非PEW组患者(Z/t=-5.358、-8.147、-5.363、 -2.297、-4.168、-2.326，P＜0.001、＜0.001、＜0.001、0.022、＜0.001、0.020)，年龄、NLR、PLR、Lp-PLA2水平均高于非PEW组(Z/t=-2.753、-5.588、-4.672、-9.269，P=0.006、＜0.001、＜0.001、＜0.001)。多因素二元Logistic逐步回归方程分析结果显示NLR(OR=1.094，95% CI：1.004～1.192，P=0.041)、PLR(OR=1.021，95% CI：1.009～1.033，P＜0.001)、Lp-PLA2(OR=1.085，95% CI：1.056～1.114，P＜0.001)水平是血液透析患者发生PEW的独立风险因子。NLR(95% CI：0.631～0.756，P＜0.001)、PLR(95% CI：0.597～0.726，P＜0.001)、Lp-PLA2(95% CI：0.735～0.841，P＜0.001)、NLR联合PLR(95% CI：0.650～0.775，P＜0.001)、NLR联合Lp-PLA2(95% CI：0.800～0.889，P＜0.001)、PLR联合Lp-PLA2(95% CI：0.782～0.875，P＜0.001)、NLR联合PLR及Lp-PLA2(95% CI：0.809～0.895，P＜0.001)在ROC曲线下面积分别为0.693、0.662、0.788、0.713、0.844、0.829、0.852，NLR、PLR、Lp-PLA2均对MHD患者发生PEW具有一定的诊断价值，且当三者联合时ROC曲线下面积为0.852(95% CI：0.809～0.895，P＜0.001)，诊断效能最大。 结论 NLR、PLR、Lp-PLA2水平可作为MHD患者发生PEW的参考指标，加强对NLR、PLR、Lp-PLA2水平的联合监测可为PEW的诊断及治疗提供干预证据。
Objective To investigate the value of neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and serum lipoprotein phospholipase A2 (Lp-PLA2) in the diagnosis of protein energy wasting in patients undergoing maintenance hemodialysis (MHD). Methods Clinical data of 327 patients with end stage renal disease (ESRD) who received MHD treatment in Taizhou People's Hospital were collected. According to the International Society of Renal Nutrition and metabolism the patients with MHD who developed PEW were divided into PEW and non-PEW groups. The application values of NLR, PLR, and serum Lp-PLA2 in the diagnosis of PEW in MHD patients were compared. Results In the PEW group, Body Mass Index (BMI) (Z=-5.358, P＜0.001), albumin (Z=-8.147, P＜0.001), prealbumin (Z=-5.363, P＜0.001), total cholesterol (Z=-2.297, P =0.022), creatinine (Z=-4.168, P＜0.001), uric acid (t=-2.326, P =0.020) levels were significantly lower than those in non-Pew group, age (Z=-2.753, P=0.006), NLR (Z=-5.588, NLR (Z=-5.588, P=0.020), and NLR (Z=-4.168, P＜0.001) were significantly lower than those in non-Pew group, P＜0.001), PLR (Z=-4.672, P＜0.001) and Lp-PLA2 (t=-9.269, P＜0.001) levels were significantly higher than those in non-Pew group. The results of multivariate binary Logistic stepwise regression equation analysis showed that NLR (OR=1.094,95% CI:1.004～1.192,P=0.041), PLR (OR=1.021, 95% CI:1.009～1.033,＜0.001), Lp-PLA2 (OR=1.085, 95% CI:1.056～1.114, P＜0.001) levels were independent risk factors for PEW in hemodialysis patients. NLR (95% CI:0.631～0.756, P＜0.001), PLR (95%CI: 0.597～0.726, P＜0.001), Lp-PLA2 (95% CI:0.735～0.841, P＜0.001), NLR combined PLR (95% CI:0.631～0.756, P＜0.001) 0.650～0.775, P＜0.001), NLR combined with Lp-PLA2 (95% CI: 0.800～0.889, P＜0.001), PLR combined with Lp-PLA2 (95% CI: 0.782～0.875, P＜0.001), NLR combined with PLR and Lp-PLA2 (95% CI: 0.809～0.895, P＜0.001) area under ROC curve were 0.693, 0.662, 0.788, 0.713, 0.844, 0.829, 0.852, respectively. NLR, PLR, Lp-PLA2 all had certain diagnostic value for the occurrence of PEW in MHD patients. The area under ROC curve was 0.852 (95% CI: 0.809～0.895, P＜0.001) when the three combined, indicating the maximum diagnostic efficiency. Conclusion NLR, PLR and serum Lp-PLA2 levels can be used as reference indicators for PEW in MHD patients, and strengthening the joint monitoring of NLR, PLR and serum Lp-PLA2 levels can provide intervention evidence for the diagnosis and treatment of PEW.
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