Research On The Relationship Between Inflammatory Cell Ratio And Cervical Atherosclerosis In Patients With Type 2 Diabetic Kidney Disease

Objective:In this study,the correlation of neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)with renal function in patients with type 2 diabetic kidney disease was analyzed by calculating the ratio of neutrophil to lymphocyte(NLR)and platelet to lymphocyte(PLR),and the correlation and clinical application value of NLR with carotid atherosclerosis were further explored.Methods:A total of 171 patients with type 2 diabetic nephropathy who were admitted to the China-Japan Union Hospital Of Jilin University from January 2020 to December 2020 were selected.Cervical artery color ultrasound was performed in the Department of Ultrasound of our hospital,and the carotid intima-media thickness(CIMT)was divided into two groups: The non-carotid atherosclerosis group: CIMT < 1.0mm,the carotid atherosclerosis group: CIMT≥1.0mm,with or without plaque formation.A total of 131 cases were collected from the carotid atherosclerosis group and 40 cases from the nonatherosclerosis group.General data and biochemical indexes of the two groups were collected,and NLR,PLR,MLR and RPR were calculated.Spearman bivariate was used to analyze the correlation between general clinical data,blood biochemical indexes and the ratio of inflammatory cells in patients with type 2 diabetic nephropathy.Risk factors for carotid atherosclerosis were analyzed by multivariate binary Logistic regression after adjusting for confounding factors.Then,NLR was divided into three groups: A,B and C,and the incidence of carotid atherosclerosis was compared between the three groups.Receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of each inflammatory cell ratio on carotid atherosclerosis in patients with type 2 diabetic kidney disease Result:1.Age,number of alcohol drinkers and SBP of type 2 diabetic kidney disease patients with carotid atherosclerosis group were significantly higher than those without carotid atherosclerosis group,and the difference was statistically significant(P <0.05).The EGFR in the carotid atherosclerosis group was significantly lower than that in the non-carotid atherosclerosis group,and the difference was statistically significant(P < 0.05).There was no significant difference in gender,smoking and DBP between the two groups(P > 0.05).2.There were statistically significant differences in ACR,A-microglobulin,CysC and Hb A1 c between the two groups(P < 0.05),and the ACR,A-microglobulin,CysC and Hb A1 c in the carotid atherosclerosis group were significantly higher than those in the non-carotid atherosclerosis group.3.The difference in LDL between the two groups was statistically significant(P< 0.05).LDL in the carotid atherosclerosis group was significantly higher than that in the non-atherosclerosis group.4.The difference in NLR between the two groups was statistically significant(P<0.05),and the NLR of the carotid atherosclerosis group was significantly higher than that of the non-carotid atherosclerosis group.5.Multivariate Logistic regression analysis with adjusted confounding factors showed that age,ACR and NLR were independent risk factors for carotid atherosclerosis and plaque formation,and were closely related to carotid atherosclerosis.6.Spearman bivariate correlation analysis showed that NLR was positively correlated with age,ACR,α-microglobulin,UREA,SCR and Cys-C,but negatively correlated with EGFR,indicating that NLR was correlated with renal function to a certain extent.7.NLR was divided into group A,B and C,and the chi-square test was used to make pair-wise and overall comparison of the three groups.The difference between group A and group B and group C was statistically significant,and the overall difference between the three groups was statistically significant.8.Receiver operating characteristic curve(ROC curve)was drawn to analyze the sensitivity and specificity of NLR for carotid atherosclerosis.ROC analysis was conducted with the presence or lack of atherosclerosis and plaque formation as state variables.The area under the ROC curve was 0.790,P=0.000,less than 0.05.When the NLR is 1.6500,it is the optimal cut-off value for the diagnosis of carotid atherosclerosis.The sensitivity and specificity of NLR for predicting carotid atherosclerosis were84.7%,70%,and Youden index 0.547.Conclusions:1.The NLR of type 2 diabetic kidney disease patients with carotid atherosclerosis was significantly higher than that of patients without carotid atherosclerosis.2.NLR was positively correlated with age,urinary microalbumin/creatinine,α-microglobulin,urea,creatinine,cystin-C,and negatively correlated with e GFR.It is suggested that NLR may be related to diabetic nephropathy and the progression of renal function.3.NLR is an independent risk factor for carotid atherosclerosis in patients with type 2 diabetic kidney disease.With the increase of NLR level,the prevalence of carotid atherosclerosis tends to increase.NLR was 79% accurate in determining whether type2 diabetic kidney disease was associated with carotid atherosclerosis.The sensitivity and specificity of NLR for predicting carotid atherosclerosis were 84.7% and 70%.