The Correlation Between Monocyte Lymphocyte Ratio And Early-stage Diabetic Kidney Disease

Objective: With high morbidity,mortality,and treatment cost,diabetic kidney disease(DKD)poses a serious threat to human health worldwide.Studies have shown that inflammation is one of the main pathogenic factors in the occurrence and development of DKD.As a promising biomarker of inflammation,the relationship between monocyte lymphocyte ratio(MLR)and early-stage DKD is not clear.The purpose of this study is to explore the relationship between MLR and early-stage DKD.Methods: A total of 235 Type 2 diabetes mellitus(T2DM)patients admitted to the First Affiliated Hospital of Jinan University from December 2019 to February 2021 were enrolled.The medical history and laboratory indexes of the patients were collected.According to the level of urinary albumin / creatinine ratio(UACR),T2 DM patients were divided into two groups: non-DKD group(n=129,UACR<30mg/g)and early-satge DKD group(n=106,30mg/g≤UACR≤300mg/g).Then the differences of medical history and laboratory indexes of the two groups were compared.According to MLR quartiles,patients with T2 DM were divided into low MLR group(MLR < 0.21),middle MLR group(0.21 ≤ MLR ≤ 0.27)and high MLR group(MLR > 0.27).The differences of medical history and laboratory indexes among the three groups were compared.The medical history data,laboratory indexes and MLR were analyzed by bivariate correlation analysis.At the same time,linear regression analysis was used to evaluate the independent influencing factors of UACR in T2 DM patients,and logistic regression analysis was used to analyze the risk factors of early-stage DKD patients to explore the relationship between MLR and early-stage DKD.Results: 1.Compared with the non-DKD group,the early DKD group had higher age,prevalence of hypertension,MLR,UACR,log UACR,hemoglobin A1 c,urea,serum creatinine and triglyceride(P<0.05),and lower hemoglobin and lymphocyte count(P<0.05).2.Compared with the low MLR group,the UACR of the patients with middle MLR was higher(P<0.05),and the levels of high-density lipoprotein,low-density lipoprotein and total cholesterol in the middle MLR group were lower(P<0.05),and the prevalence rate of early DKD,UACR,log UACR,age and urea in the high MLR group were higher(P < 0.05),hemoglobin,triglyceride and low-density lipoprotein were lower in patients with high MLR(P<0.05).Compared with the middle MLR group,the age of the high MLR group was older(P<0.05),and the hemoglobin of the high MLR group was lower(P<0.05).3.In bivariate correlation analysis,age,sex,course of diabetes,history of hypertension,monocyte count,UACR,log UACR,urea,serum creatinine and fasting plasma glucose were positively correlated with MLR in T2 DM patients(P<0.05),while hemoglobin,lymphocyte count,total cholesterol and albumin were negatively correlated with MLR in patients with T2DM(P<0.05).4.In multivariate linear regression analysis,MLR,age,course of diabetes,history of hypertension,hemoglobin A1 c,albumin,fasting plasma glucose,urea,serum creatinine and triglyceride were included in model 1.The results showed that history of hypertension,hemoglobin A1 c,urea,triglyceride and MLR were independently correlated with log UACR in patients with T2DM(P < 0.05).In model 2,the three intervals of MLR,age,course of diabetes,history of hypertension,hemoglobin A1 c,albumin,fasting plasma glucose,urea,serum creatinine and triglyceride were included,the results showed that high MLR level(compared with low MLR level),history of hypertension,hemoglobin A1 c and urea were independently associated with log UACR in patients with T2DM(P < 0.05).5.In multivariate logistic regression analysis,MLR,age,course of diabetes,history of hypertension,hemoglobin A1 c,urea,serum creatinine and triglyceride were included in model 1.The results showed that MLR,history of hypertension,hemoglobin A1 c,urea and triglyceride were independently correlated with early-stage DKD,and all of them were independent risk factors for early-stage DKD(P<0.05).In model 2,the three intervals of MLR,age,course of diabetes,history of hypertension,hemoglobin A1 c,urea,serum creatinine and triglyceride were included,the results showed that high MLR level(compared with low MLR level),history of hypertension,hemoglobin A1 c,urea and triglyceride were independently correlated with early-stage DKD,and all of them were independent risk factors for early-stage DKD(P<0.05).Conclusions: This study shows that MLR is independently associated with early-stage DKD patients and it is an independent risk factor for early-stage DKD.Because of its advantages of easy detection and low cost,MLR may be an effective index to evaluate the inflammatory state and disease severity of patients with early-stage DKD,but further large-sample multicenter follow-up studies are needed to explore the relationship between MLR and early-stage DKD.