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.
LI Zhao-Ting
,
JU Ping-Ping
,
ZOU Chun-Bo
. Combined diagnostic value of NLR, PLR and Lp-PLA2 for protein energy consumption in maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2024
, 23(05)
: 334
-337,363
.
DOI: 10.3969/j.issn.1671-4091.2024.05.003
[1]HU C, ZHANG Y, BI X, et al.Correlation between serum trimethylamine-N-oxide concentration and protein energy wasting in patients on maintenance hemodialysis[J].Ren Fail, 2022, 44(1):1669-76
[2]IKIZLER T A, CANO N J, FRANCH H, et al.Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism[J].Kidney Int, 2013, 84(6):1096-107
[3]ZHOU Chang-ju , CAO Juan ， ZHANG Xu, .Protein-energy wasting and its related factors in maintenance dialysis patients[J].Chinese Journal of Blood Purification, 2016, 15(09):483-7
[4]DEN HOEDT C H, BOTS M L, GROOTEMAN M P, et al.Clinical predictors of decline in nutritional parameters over time in ESRD[J].Clin J Am Soc Nephrol, 2014, 9(2):318-25
[5]BOIVIN M A, BATTAH S I, DOMINIC E A, et al.Activation of caspase-3 in the skeletal muscle during haemodialysis[J].Eur J Clin Invest, 2010, 40(10):903-10
[6]GRATEROL TORRES F, MOLINA M, SOLER-MAJORAL J, et al.Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease[J].Nutrients, 2022, 14(20):-
[7]胡秀红, 杨洪娟, 崔红蕊.血小板淋巴细胞比值、中性粒细胞淋巴细胞比值与高通量血液透析患者蛋白质能量消耗的相关性[J].中国临床医生杂志, 2021, 49(1):41-4
[8]HUANG F, WANG K, SHEN J.Lipoprotein-associated phospholipase A2: The story continues[J].Med Res Rev, 2020, 40(1):79-134
[9]谢潭, 杨合英, 侯广军.外周血中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值评估神经母细胞瘤患者预后的价值[J].中华普通外科杂志, 2018, 33(2):122-5
[10]ANTóN-PéREZ G, SANTANA-DEL-PINO á, HENRíQUEZ-PALOP F, et al.Diagnostic Usefulness of the Protein Energy Wasting Score in Prevalent Hemodialysis Patients[J].J Ren Nutr, 2018, 28(6):428-34
[11]HERSELMAN M, MOOSA M R, KOTZE T J, et al.Protein-energy malnutrition as a risk factor for increased morbidity in long-term hemodialysis patients[J].J Ren Nutr, 2000, 10(1):7-15
[12]CARRERO J J, THOMAS F, NAGY K, et al.Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism[J].J Ren Nutr, 2018, 28(6):380-92
[13]JANKOWSKA M, COBO G, LINDHOLM B, et al.Inflammation and Protein-Energy Wasting in the Uremic Milieu [J].Contrib Nephrol, 2017, 191:58-71
[14]KOPPE L, FOUQUE D, KALANTAR-ZADEH K.Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers[J].J Cachexia Sarcopenia Muscle, 2019, 10(3):479-84
[15]DELANO M J, MOLDAWER L L.The origins of cachexia in acute and chronic inflammatory diseases[J].Nutr Clin Pract, 2006, 21(1):68-81
[16]LI X, CAO Y, LIU Z, et al.The Relationship between Liver Injury and Serum Levels of C-Reactive Protein and Procalcitonin in Patients with Acute Pancreatitis[J].J Coll Physicians Surg Pak, 2019, 29(3):287-9
[17]LV S L, ZENG Z F, GAN W Q, et al.Lp-PLA2 inhibition prevents Ang II-induced cardiac inflammation and fibrosis by blocking macrophage NLRP3 inflammasome activation[J].Acta Pharmacol Sin, 2021, 42(12):2016-32
[18]唐宽平, 董哲毅, 王远大.不同年龄组血液透析患者蛋白质能量消耗评估及比较[J].中华肾病研究电子杂志, 2018, 7(2):65-70
[19]DENG M, YIN Y, ZHANG Q, et al.Identification of Inflammation-Related Biomarker Lp-PLA2 for Patients With COPD by Comprehensive Analysis[J].Front Immunol, 2021, 12:670-971
