中性粒细胞/淋巴细胞比值与IgA肾病Lee氏分级、牛津分型的相关性分析

doi:10.3969/j.issn.1004-583X.2021.05.009

摘要/Abstract

摘要：

目的探讨中性粒细胞/淋巴细胞比值(NLR)与免疫球蛋白A(IgA)肾病Lee氏分级、牛津分型的相关性。方法选取80例IgA肾病患者的临床和病理资料,根据IgA肾病病理Lee氏分级及牛津分型间质纤维化与肾小管萎缩(T)分级分组,根据牛津分型新月体(C)分级分为2组。检测NLR、超敏C反应蛋白(hsCRP)、血肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白水平,采用肾脏病饮食改良公式估算肾小球滤过率(eGFR),分析NLR与IgAN病理Lee氏分级、牛津分型及肾功能临床指标相关性。结果在Lee氏分级和牛津分型中,伴随肾脏病理损伤程度加重,NLR、SCr、BUN、24 h尿蛋白水平逐渐加重,eGFR下降(P<0.05)。NLR与Lee氏分级及牛津分型中T、C分级呈正相关(P<0.05),与SCr、BUN、24 h尿蛋白水平呈正相关(P<0.05),与eGFR呈负相关(P<0.05)。结论 NLR能反映IgA肾病患者疾病炎症状态及活动性,且与病理损害程度及肾脏功能有较好的相关性,对评估IgA肾病肾脏损伤程度及预后有一定价值。

关键词: 肾小球肾炎, IGA, 中性粒细胞/淋巴细胞, Lee氏分级, 牛津分型

Abstract:

Objective To analyze the correlation between neutrophil /lymphocyte ratio(NLR) and Lee’s grading and Oxford classification of immunoglobulin A (IgA) nephropathy. Methods The data of clinical and pathological of 80 IgA nephropathy patients were selected, the patients were subject to the grading and grouping based on Lee's grading standard for pathology of IgA nephropathy, interstitial fibrosis and tubuloatrophy (T) grading standard of Oxford classification and were divided into two groups according to the crescents (C) grading standard of Oxford classification.The serum NLR,hypersensitive C-reactive protein (hsCRP), serum creatinine (SCr), blood urea nitrogen (BUN), 24 h urinary protein were determined. The glomerular filtration rate(eGFR) was estimated by modification of diet in renal disease equation. The correlation of NLR with Lee’s grading, Oxford classification and various clinical indicators of renal function were analyzed. Results In Lee’s grading and Oxford classification, NLR,SCr, BUN and 24 h urinary protein were gradually increased with the aggravating degree of renal pathological lesions, while eGFR gradually decreased (P<0.05). NLR was positively correlated with T and C gradings in Lee’s grading and Oxford classification as well as SCr, BUN, 24 h urinary protein (P<0.05),but negatively correlated with eGFR(P<0.05). Conclusion NLR can reflect the inflammatory state and activity of IgA nephropathy patients, and it is greatly correlated with the degree of pathological damage and renal function, delivering certain value in evaluating the renal injury degree and prognosis of IgA nephropathy.

Key words: glomerulonephritis, IGA, neutrophil/lymphocyte, Lee’s grading, Oxford classification

中图分类号:

R692.31

刘佳丽, 谢荣, 李雪莲, 刘晓惠. 中性粒细胞/淋巴细胞比值与IgA肾病Lee氏分级、牛津分型的相关性分析[J]. 临床荟萃, 2021, 36(5): 432-435.

Liu Jiali, Xie Rong, Li Xuelian, Liu Xiaohui. Correlation analysis between neutrophil/lymphocyte ratio with Lee’s grading and Oxford classification of IgA nephropathy[J]. Clinical Focus, 2021, 36(5): 432-435.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.05.009

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I5/432

图/表 6

参考文献 19

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等级	病理表现
Ⅰ级	肾小球绝大多数正常,偶尔轻度系膜增宽(节段)伴和(或)不伴细胞增生,肾小管和肾间质没有改变。
Ⅱ级	肾小球示局灶系膜增殖和硬化(<50%),有罕见小的新月体,肾小管和肾间质无损害。
Ⅲ级	肾小球呈弥漫性系膜增值和增宽(偶尔局灶节段),偶见小新月体;肾小管和肾间质改变则呈现出局灶性肾间质水肿,偶见细胞浸润,罕见肾小管萎缩。
Ⅳ级	肾小球病变呈重度弥漫性系膜增生和硬化,部分或全部肾小球硬化,可见新月体(<45%)。肾小管萎缩,肾间质浸润,偶见肾间质泡沫细胞。
Ⅴ级	肾小球病变的性质类似Ⅳ级,但更严重,肾小球新月体形成>45%;肾小管和肾间质病变类似于Ⅳ级,但更严重。

等级	病理表现
Ⅰ级	肾小球绝大多数正常,偶尔轻度系膜增宽(节段)伴和(或)不伴细胞增生,肾小管和肾间质没有改变。
Ⅱ级	肾小球示局灶系膜增殖和硬化(<50%),有罕见小的新月体,肾小管和肾间质无损害。
Ⅲ级	肾小球呈弥漫性系膜增值和增宽(偶尔局灶节段),偶见小新月体;肾小管和肾间质改变则呈现出局灶性肾间质水肿,偶见细胞浸润,罕见肾小管萎缩。
Ⅳ级	肾小球病变呈重度弥漫性系膜增生和硬化,部分或全部肾小球硬化,可见新月体(<45%)。肾小管萎缩,肾间质浸润,偶见肾间质泡沫细胞。
Ⅴ级	肾小球病变的性质类似Ⅳ级,但更严重,肾小球新月体形成>45%;肾小管和肾间质病变类似于Ⅳ级,但更严重。

病变部位	分级	病理表现
系膜增殖(M)	M0	<4个系膜细胞/系膜区
	M1	≥4个系膜细胞/系膜区
毛细血管内增生性病变(E)	E0	无增生性病变
	E1	有增生性病变
节段硬化与粘连(S)	S0	无硬化或粘连
	S1	有硬化或粘连
间质纤维化与小管萎缩(T)	T0	纤维化或萎缩≤25%
	T1	25%<纤维化或萎缩≤50%
	T2	纤维化或萎缩>50%
新月体(C)	C0	无新月体
	C1	有新月体,且新月体<25%
	C2	有新月体,且新月体≥25%

病变部位	分级	病理表现
系膜增殖(M)	M0	<4个系膜细胞/系膜区
	M1	≥4个系膜细胞/系膜区
毛细血管内增生性病变(E)	E0	无增生性病变
	E1	有增生性病变
节段硬化与粘连(S)	S0	无硬化或粘连
	S1	有硬化或粘连
间质纤维化与小管萎缩(T)	T0	纤维化或萎缩≤25%
	T1	25%<纤维化或萎缩≤50%
	T2	纤维化或萎缩>50%
新月体(C)	C0	无新月体
	C1	有新月体,且新月体<25%
	C2	有新月体,且新月体≥25%

组别	例数	NLR	hsCRP (mg/L)	SCr (μmol/L)	BUN (mmol/L)	eGFR [ml/(min· 1.73 m²)]	24 h尿蛋白 (mg)
Ⅰ~Ⅱ级组	42	2.00(1.62,2.46)	0.73(0.25,2.02)	73.20(55.35,93.35)	4.835(3.880,5.573)	100.67±32.07	800.95(400.88,1 663.35)
Ⅲ级组	14	2.57(2.06,3.19)	0.87(0.23,1.66)	82.95(68.70,102.00)	5.255(4.345,5.873)	85.32±23.39	2 435.20(1 105.88,4 796.30)
Ⅳ~Ⅴ级组	18	3.20(2.82,4.26)	1.91(0.33,2.90)	126.40(95.95,162.65)	6.540(5.365,9.525)	57.79±24.94	4 215.55(3 218.35,6 428.68)
统计值		χ²=22.891	χ²=1.164	χ²=17.505	χ²=9.723	F=15.187	χ²=31.25
P值		<0.05	>0.05	<0.05	<0.05	<0.05	<0.05