目的 研究平均血小板体积(mean platelet volume,MPV)及中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)联合C反应蛋白(CRP)对维持性血液透析(maintenance hemodialysis,MHD)患者心血管疾病(cardiovascular disease,CVD)发生风险的预测价值。 方法 选取2018年8月—2023年6月在民航总医院肾内科确诊为尿毒症且行规律血液透析的患者，按是否发生心血管死亡事件分为心血管死亡事件组和存活组，收集人口学资料包括年龄、性别、体质量指数(body mass index,BMI)、透析龄及实验室资料(血常规、生化等)，用二元Logistic回归分析筛选独立危险因素，采用ROC曲线进行预测效能分析。 结果 共纳入267例患者，其中存活组228例，心血管死亡事件组39例。 ①2组患者年龄(t=-1.835,P=0.068)、性别(χ2=3.515,P=0.061)、BMI(t=1.971,P=0.051)、透析龄(t=-1.092,P=0.062)等一般资料比较差异无统计学意义。②心血管死亡事件组MPV、NLR、CRP较存活组高(Z/t分别为-7.456、-5.340、-5.416,均P＜0.001)。心血管死亡事件组白蛋白(ALB)、血肌酐(Cr)、钙(Ca)、磷(P)、血红蛋白(Hb)较存活组低(Z/t分别为5.968、5.168、4.375、-3.552、-2.052,P分别为＜0.001、 ＜0.001、
＜0.001、0.040、0.039)。③MPV(OR=7.182,95% CI：2.974～17.348,P＜0.001)、NLR(OR=1.203,95% CI：1.015～1.427,P=0.033)、CRP(OR=1.127,95% CI：1.098～1.258,P=0.042)升高及Hb(OR=1.062,95% CI：1.007～1.319,P=0.027)、Ca(OR=0.006,95% CI：0.000～0.184,P=0.003)降低是引起MHD患者并发心血管死亡事件的独立危险因素。④ROC曲线分析结果示MPV(AUC=0.881,95% CI：0.821～0.940,P＜0.001)、NLR(AUC=0.764,95% CI：0.668～0.860,P＜0.001)、CRP(AUC=0.778,95% CI：0.677～0.878,P＜0.001)及三者联合对MHD患者心血管死亡事件均具有预测价值，三者联合的AUC大于单一指标(AUC=0.931,95% CI：0.882～0.980,P＜0.001)。结论 MPV、NLR、CRP升高及Hb、Ca降低是MHD患者发生心血管死亡事件的独立危险因素。MPV、NLR、CRP及三者联合对MHD患者心血管死亡事件具有预测价值，三者联合的预测价值更具临床指导意义。
Objective Explore the predictive value of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) combined with C-reactive protein (CRP) for cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients. Method Selecting patients diagnosed with uremia and undergoing MHD in nephrology department of Civil Aviation General Hospital from August 2018 to June 2023, patients were divided into survival group and cardiovascular death group based on the occurrence of cardiovascular death events. Demographic data including age, gender, body mass index (BMI), dialysis age and laboratory data (blood routine, biochemical routine) were collected. Independent risk factors were identified by using on logistic regression analysis, and receiver operator characteristic (ROC) curves were used for predictive performance analysis. Result A total of 267 patients were included, including 228 of survival group and 39 of cardiovascular death group.1. There were no statistically significant difference in general data such as age (t= -1.835, P=0.068), gender (χ2=3.515, P=0.061), BMI (t=1.971, P=0.051), and dialysis age (t=-1.092, P=0.062) between the two groups. 2. MPV [11.30(10.4, 12.6)] fL, NLR [6.75(4.8, 12.7)], and CRP [15.80(5.8, 64.5)]mg/L in cardiovascular death event group were significantly higher than survival group (Z/t values were -7.456, -5.340, -5.416, respectively, all P＜0.001). While albumin (ALB), creatinine (Cr), calcium (Ca), phosphorus (P), and hemoglobin (Hb) were significantly lower than survival group (Z/t values were 5.968, 5.168, 4.375, -3.552, -2.052, and P were ＜0.001, ＜0.001, ＜0.001, 0.040, 0.039, respectively). 3. Elevated levels of MPV (OR=7.182, 95% CI：2.974 ～17.348, P＜0.001)、NLR (OR=1.203, 95% CI：1.015 ～1.427, P=0.033)、CRP (OR=1.127, 95% CI：1.098 ～1.258, P=0.042) and decreased levels of Hb (OR=1.062, 95% CI：1.007～1.319, P=0.027)、Ca (OR=0.006, 95% CI：0.000～0.184,P=0.003) were independent risk factors for cardiovascular death in MHD patients. 4. ROC curve analysis indicated MPV (AUC= 0.881, 95% CI：0.821～0.940, P＜0.001), NLR (AUC= 0.764, 95% CI：0.668～0.860, P＜0.001), CRP (AUC= 0.778, 95% CI：0.677～0.878, P＜0.001), and their combined factors (including MPV, NLR, and CRP) have predictive value for cardiovascular death events in MHD patients, and the area under the curve (AUC) of combined factors was higher than the single indicator (AUC=0.931, 95% CI: 0.882～0.980, P＜0.001). Conclusion Elevated MPV, NLR, CRP, and decreased Hb and Ca were independent risk factors for cardiovascular death in MHD patients. MPV, NLR, CRP, and their combined factors have a predictive value for cardiovascular death events in MHD patients, and the predictive value of their combined factors has greater clinical guidance significance.
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