Study On The Correlation Between The Ratio Of Neutrophils To Lymphocytes,the Distribution Width Of Red Blood Cells And The Target Organ Damage In Hypertension

Objective:To explore whether the ratio of neutrophil to lymphocyte count(NLR)and red blood cell distribution width(RDW)are risk factors for target organ damage(carotid atherosclerosis,left ventricular hypertrophy,renal function damage)in hypertensive patients,and to evaluate the predictive value of NLR and RDWon target organ damage in hypertensive patients,It provides theoretical referencefor theearly evaluation of target organ damage inhypertension.Methods:The patients with essential hypertension admitted to the First Affiliated Hospital of Gannan Medical College from September 2021 to October 2022 were selected as the study subjects.According to the inclusion and exclusion criteria,318 patients were finally included.They were divided into simple hypertension group(90 cases)according to different target organ damage Hypertension with carotid atherosclerosis group(84 cases),hypertension with left ventricular hypertrophy group(68 cases)and hypertension with renal dysfunction group(76cases).The general clinical information,NLR,RDW levels and other biochemical indicators between simple hypertension and other three groups of patients were compared by univariate analysis.The Spearman correlation coefficient was used to evaluate the correlation between NLR,RDW and different target organ damage in patients.The ROC curve was used to evaluate the predictive value of NLR,RDW alone or combined diagnosis for hypertension patients with different target organ damage.Results:1.There was no significant difference in sex,alcohol consumption,SBP,TC,HDL-C,DBP,TG,FPG,Scr,UA,e GFR between the simple hypertension group and the hypertension group with carotid atherosclerosis(P>0.05);The age,NEUT,smoking,LDL-C and NLR of hypertension group with carotid atherosclerosis were higher than those of simple hypertension group,while the levels of BMI,LYM and RDW were lower than those of simple hypertension group,with statistical significance(P<0.05).Spearman correlation analysis showed that NLR was positively correlated with hypertension with carotid atherosclerosis(r=0.526,P<0.01),and RDW was positively correlated with hypertension with carotid atherosclerosis(r=0.480,P< 0.01).Taking hypertension with carotid atherosclerosis as the dependent variable,multivariate logistic regression analysis showed that smoking,age,NLR,RDW,HDL-C were independent risk factors for hypertension with carotid atherosclerosis(P<0.05).The sensitivity and specificity of NLR and RDW in predicting hypertension with carotid atherosclerosis were evaluated by ROC curve.The results showed that the sensitivity and specificity of NLR were91.7% and 62.2%,and the area under the ROC curve was 0.804(95% CI: 0.738-0.870,P<0.01);The sensitivity and specificity of RDW were 82.1% and 63.3%,and the area under the ROC curve was 0.776(95% CI: 0.738 ～ 0.870,P<0.01);The sensitivity and specificity of combined diagnosis were 82.1% and 83.3%,and the area under the ROC curve was 0.891(95% CI: 0.843 ～ 0.939,P<0.01).The sensitivity and accuracy of the combined diagnosis were not significantly different from those of NLR and RDW.The specificity of the combined diagnosis was higherthanthat of NLR and RDW(P<0.05).2.There was no significant difference in sex,alcohol consumption,TC,HDL-C,BMI,DBP,LDL-C,TG,UA,e GFR between the simple hypertension group and the hypertension group with left ventricular hypertrophy(P>0.05);The age,NEUT,SBP,Scr,smoking,FPG and NLR of hypertension group with left ventricular hypertrophy were higher than those of simplehypertension group,while the levels of LYM and RDWwere lower than those of simple hypertension group(P<0.05).Spearman correlation analysis showed that NLR was positively correlated with hypertension with left ventricular hypertrophy(r=0.459,P<0.01),and RDW was positively correlated with hypertension with left ventricular hypertrophy(r=0.358,P<0.01).Taking hypertension with left ventricular hypertrophy as the dependent variable,the results of multivariate logistic regression analysis showed that smoking,age,NLR,SBP and RDW were independent risk factors for hypertension with left ventricular hypertrophy(P<0.05).The sensitivity and specificity of NLR and RDW in predicting hypertension with left ventricular hypertrophy were evaluated by ROC curve.The results showed that the sensitivity and specificity of NLR were 92.6% and 47.8%,and the area under the ROC curve was 0.676(95% CI: 0.592 ～ 0.760,P<0.01);The sensitivity and specificity of RDW were 88.2% and35.6%,and the area under the ROC curve was 0.669(95% CI: 0.586-0.752,P<0.01);The sensitivity and specificity of combined diagnosis were 89.7% and 53.3%,and the area under the ROC curve was 0.752(95% CI: 0.677-0.826,P<0.01).The sensitivity and accuracy of the combined diagnosis were not significantly different from those of NLR and RDW.The specificity of the combined diagnosis was higherthanthat of NLR and RDW(P<0.05).3.There was no significant difference in alcohol consumption,TC,HDL-C,smoking,BMI,DBP,LDL-C and UA between simple hypertension group and hypertension with renal function impairment group(P>0.05);The sex,age,NEUT,SBP,Scr,TG,e GFR and NLR of the hypertension group with renal function damage were higher than those of the simple hypertension group,while the levels of LYM and RDW were lower than those of the simple hypertension group,with statistical significance(P<0.05).Taking whether hypertension is accompanied by renal function damage as the dependent variable,the results of multivariate logistic regression analysis showed that sex,age,Scr,e GFR,NLR,TG,RDW were independent risk factors of hypertension with renal function damage(P<0.05).The sensitivity and specificity of NLR and RDW in predicting hypertension with renal function impairment were evaluated by ROC curve.The results showed that the sensitivity and specificity of NLR were 85.5% and 75.6%,and the area under the ROC curve was 0.810(95% CI: 0.740-0.879,P<0.01);The sensitivity and specificity of RDWwere 86.8% and 72.2%,and the area under the ROC curve was 0.686(95% CI: 0.606-0.766,P<0.01);The sensitivity and specificity of combined diagnosis were 92.1% and 41.1%,and the area under the ROC curve was 0.843(95% CI: 0.782 ～ 0.904,P<0.01).There was no statistical difference between the sensitivity of combined diagnosis and NLR and RDW.The specificity and accuracy of combined diagnosis were higher than those of NLR and RDW(P<0.05).However,compared with the AUC value of NLR,there is no significant statistical difference,as shown in Table 12 and Figure9.Conclusion:1.NLR and RDW are independent risk factors of target organ damage(carotid atherosclerosis,left ventricular hypertrophy,renal function damage)inhypertensive patients.2.NLR and RDW have good sensitivity and specificity,and their combined diagnosis has higher diagnostic efficiency,which has important clinical value for early identification of target organ damagein hypertension.