中性粒细胞与淋巴细胞比值和胆红素与2型糖尿病周围血管病变的相关性研究

目的探讨中性粒细胞与淋巴细胞比值(NLR)、胆红素与2型糖尿病周围血管病变的相关性。方法回顾性分析安徽省第二人民医院2018年3月至2019年12月在内分泌科就诊的205例2型糖尿病患者,按有无周围血管并发症分为无血管病变组(DM组,n=102)、周围血管病变组(PV组,n=103)。观察2组临床指标及生化指标的差异,分析2型糖尿病周围血管病变的危险因素。采用受试者工作特征(ROC)曲线评估NLR与胆红素对2型糖尿病周围血管病变的诊断效能。结果与DM组相比,PV组患者年龄、病程、NLR水平升高,淋巴细胞(L)、直接胆红素(DBIL)、间接胆红素(IBIL)、总胆红素(TBIL)下降,差异有统计学意义(P<0.05)。Pearson相关分析显示NLR与血小板(PLT)、空腹血糖(FPG)、病程呈正相关(P<0.05),与IBIL、总胆固醇(TC)呈负相关(P<0.05)。IBIL与TC、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)呈正相关(P<0.05),与白细胞(WBC)、中性粒细胞(N)、NLR、病程呈负相关(P<0.05)。Logistic回归分析结果显示,病程长(OR=1.081,95%CI:1.016~1.150,P<0.05)、高NLR(OR=1.086,95%CI:1.055~1.119,P<0.05)、低IBIL(OR=-0.925,95%CI:0.863~0.991,P<0.05)是2型糖尿病周围血管病变的独立危险因素。ROC曲线显示NLR诊断2型糖尿病周围血管病变的曲线下面积为0.707(95%CI:0.648~0.766),当NLR截点为2.66,诊断敏感度为83.7%,特异度为48.4%;IBIL的曲线下面积为0.439(95%CI:0.375~0.503)。结论高NLR、低IBIL与2型糖尿病周围血管病变相关,NLR对2型糖尿病周围血管病变有一定的预测价值。

Correlation between neutrophil-to-lymphocyte ratio,bilirubin and type 2 diabetes mellitus with peripheral vascular complications

Objective To investigate the correlation between neutrophil-to-lymphocyte ratio(NLR),bilirubin and peripheral vascular complications in type 2 diabetes mellitus(T2DM).Methods A total of 205 patients with T2DM treated in the endocrine department of Anhui No.2 Provincial People's Hospital from March 2018 to December 2019 were retrospective studied and divided into the non-vascular lesion group(DM group,n=102),the peripheral vascular complications group(PV group,n=103)according to the presence or absence of peripheral vascular complications.The clinical and biochemical parameters in two groups were observed and the risk factors of type 2 diabetic peripheral vascular complications were analyzed.Meanwhile,the diagnostic efficiency of NLR and bilirubin were evaluated by receiver operating characteristic(ROC)curve.Results Compared with the DM group,age,disease duration,NLR increased,while lymphocytes(L),direct bilirubin(DBIL),indirect bilirubin(IBIL),and total bilirubin(TBIL)decreased in the PV group with statistical significance(P<0.05).Pearson correlation analysis showed that NLR was positively correlated with platelet(PLT),fasting plasma glucose(FPG)and disease duration(P<0.05),negatively correlated with IBIL and total cholesterol(TC)(P<0.05).IBIL was positively correlated with TC,high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)(P<0.05),negatively correlated with white blood cell(WBC),neutrophil(N),NLR and disease duration(P<0.05).Logistic regression analysis showed that long disease duration(OR=1.081,95%CI:1.016-1.150,P<0.05),high NLR(OR=1.086,95%CI:1.055-1.119,P<0.05)and low IBIL(OR=0.925,95%CI:0.863-0.991,P<0.05)were independent risk factors for type 2 diabetic peripheral vascular complications.ROC curve showed that the area under the curve of NLR diagnosis of type 2 diabetes with peripheral vascular complications was 0.707(95%CI:0.648-0.766).When the cutoff point of NLR was 2.66,the diagnostic sensitivity was 83.7%and the specificity was 48.4%.While the area under the curve of bilirubin was 0.439(95%CI:0.375-0.503).Conclusion High NLR and low IBIL are correlated with peripheral vascular complications in type 2 diabetes mellitus,and NLR is expected to be a good predictor for diabetic peripheral vascular complications.