Correlation Analysis Of NHR,LHR,MHR And Severity Of Type 2 Diabetic Nephropathy

Objective:By collecting the data of neutrophil,lymphocyte,monocyte and high density lipoprotein cholesterol（HDL-C）in diabetic kidney disease（DKD）patients caused by type 2 diabetes mellitus（T2DM）,neutrophil to HDL-C ratio（NHR）,lymphocyte to HDL-C ratio（LHR）and monocyte to HDL-C ratio（MHR）were calculated.To explore the correlation between NHR,LHR,MHR and the index of disease severity,and analyze the correlation between NHR,LHR,MHR and DKD.Method:A total of 458 patients admitted to the nephrology department of the First Hospital of Jilin University and diagnosed with DKD caused by T2DM and who met the screening criteria were selected from January 1,2018 to February 10,2022.According to the stage of chronic kidney disease,it was divided into three groups,namely CKD1-2 group（DKD1 group）,CKD3-4 group（DKD2 group）and CKD5 group（DKD3 group）,with 159 cases,156 cases and 143 cases respectively.A total of 150 patients diagnosed with T2DM without renal damage after being admitted to endocrinology department of our hospital at the same time were randomly selected as DM group.General clinical data,such as age,gender,BMI,hypertension,SBP,DBP,DM course,DM retinopathy,as well as laboratory indicators,such as WBC,NE,Lym,Mono,RBC,Hb,HCT,TC,TG,HDL-C,LDL-C,ALB,Urea,UA,Cr,eGFR,RBP,Cys C,Ca,P,HbAlc,24h UTP,24h UMA were collected and sorted.Statistical software was used to analyze the relationship between NHR,LHR,MHR and other indicators in each group,so as to explore the correlation between NHR,LHR,MHR and the severity of DKD disease.Results:（1）The difference of NHR,LHR and MHR between the DKD group and the DM group was statistically significant（P<0.05）.NHR and MHR in DKD group were significantly higher than those in DM group（P<0.05）,while LHR was significantly lower than that in DM group（P<0.05）.（2）Compared to groups DKD1,DKD2 and DKD3,NHR and MHR were statistically significant differences between groups（P<0.05）,and DKD3 group was significantly higher than DKD1 group.There was no significant difference between LHR groups（P>0.05）.（3）In DKD patients,NHR was negatively correlated with RBC,HCT and eGFR（r=-0.096、-0.107、-0.158,P<0.05）,and positively correlated with ALB,Urea,UA,Cr and Cys-C（r=0.143、0.098、0.163、0.174、0.152,P<0.05）.（4）In DKD patients,MHR was negatively correlated with eGFR,24h UTP and 24h UMA（r=-0.126、-0.105、-0.133,P<0.05）,and positively correlated with ALB,UA,Cr and Cys-C（r=0.180、0.227、0.147、0.151,P<0.05）.（5）Using eGFR as the dependent variable,the unitary linear regression analysis showed that eGFR in DKD patients was negatively correlated with WBC,NE,Mono,Urea,UA,Cr,RBP,Cys C,P,24h UTP,24h UMA,NHR and MHR（P<0.05）,and positively correlated with RBC,Hb,HCT,TC,ALB,Ca and HbAlc（P<0.05）.（6）Multiple stepwise linear regression analysis with eGFR as the dependent variable showed that Cys-C,Hb,24h UTP,RBP,UA,Urea,MHR,P and HbA1c was an independent risk factor for eGFR,and the regression variance was y=64.741-9.358χ₁+0.390χ₂-0.002χ₃-0.243χ₄-0.032χ₅-0.961χ₆-12.993χ₇+7.618χ₈+1.558χ₉（y=eGFR;χ₁=Cys-C;χ₂=Hb;χ₃=24h UTP;χ₄=RBP;χ₅=UA;χ₆=Urea;χ₇=MHR;χ₈=P;χ₉=HbA1c）.Conclusions:（1）The NHR and MHR of DKD patients were higher than those of DM patients,while the LHR was lower than that of DM patients.It is suggested that NHR and MHR can better respond to inflammation,oxidative stress and lipid metabolism disorder of DKD.（2）The higher the NHR and MHR,the more serious the renal lesion and anemia of DKD.The results indicated that NHR and MHR were positively correlated with the severity of DKD.（3）MHR was an independent risk factor for predicting eGFR in DKD patients.