| Background Diabetic kidney disease(DKD)is one of the most common microvascular complications of type 2 diabetes mellitus(T2DM).With the improvement of people’s living standards and changes in lifestyle,the prevalence of diabetes is increasing year by year.The earliest change in DKD is glomerular hyper filtration,followed by microalbuminuria and macro albuminuria,followed by a decrease in glomerular filtration rate(GFR),and finally end-stage renal disease(end stage renal disease ESRD)is one of the leading causes of death in diabetic patients.Early DKD has no obvious clinical symptoms,but with the long-term hyperglycemia state of the body,a large amount of proteinuria gradually appears,which eventually leads to ESRD and even death.Therefore,early prediction and treatment of DKD is extremely important in clinic.In recent years,several studies have identified new pathways involved in the development and progression of DKD,clearly demonstrating that inflammation plays an integral role in the pathogenesis of DKD.The ratio of neutrophil(Ne)count to lymphocyte(Lym)count(neutrophil to lymphocyte ratio,NLR)in peripheral blood is a new marker reflecting systemic chronic inflammation.NLR is a simple,readily available,and inexpensive subclinical inflammatory marker that has been shown to be significantly associated with diseases such as cardiovascular disease,malignancy,and metabolic syndrome.Peripheral blood red blood cell distribution width(red blood cell distribution width,RDW)is an index to measure the heterogeneity of circulating red blood cells,and it is also considered as a new type of inflammation marker.Studies have shown that RDW is an effective predictor of diabetic nephropathy or other diabetes-related complications.Therefore,this study explored the relationship between NLR,RDW levels and early DKD in T2 DM patients.Whether there is a correlation between NLR and RDW levels and the occurrence and development of early DKD provides clinical data support,thereby providing new ideas for future clinical work.Objective To investigate the correlation between NLR,RDW and early diabetic nephropathy in patients with type 2 diabetes and the feasibility of diagnosing early DKD.Methods According to the inclusion and exclusion criteria,492 patients with type 2 diabetes mellitus who were hospitalized d in the endocrine department of our hospital between September 2020 and October 2022 were selected.The study population was divided into T2 DM group(247 cases)and early DKD group(245 cases).The levels of NLR and RDW were divided into four groups according to quartiles,namely NLR-Q1(≤1.70),NLR-Q2(1.70-2.20),NLR-Q3(2.20-2.90),NLR-Q4(≥2.90),RDW-Q1(≤12.5%),RDW-Q2(12.5-12.9%),RDW-Q3(12.9-13.3%),RDW-Q4(≥13.3%).General information of all patients,such as personal history,family history,etc.was collected from the inpatient system of our hospital.Laboratory indicators such as blood routine,liver function,kidney function,etc.The collected data were statistically analyzed using SPSS 26.0 software.The measurement data are expressed as mean ± standard deviation or median(P25,P75),and the count data are expressed as rates and constituent ratios;the t test is used for the comparison of two groups of measurement data that conform to the normal distribution,and the non-normal distribution is used to compare the measurement data of the two groups that do not conform to the normal distribution.Parameter test,chi-square test was used for comparison of count data between groups;Pearson or Spearman correlation was used to analyze the relationship between serum NLR,RDW levels and renal function indicators in early DKD patients;binary Logistic regression was used to analyze the influencing factors of early DKD;ROC curve was used to evaluate the efficacy of NLR,RDW and their combination in predicting early DKD.difference was statistically significant(P < 0.05).Results 1.A total of 492 cases in T2 DM patients,among which 303 were male,female 189 cases.Pure T2 DM group(T2DM)a total of 247 cases,early T2 DM combined DKD group(DKD group)245 cases.2.T2 DM and DKD groups in DR medical history,age,disease duration,SBP,DBP,FPG,HbA1c,TG,HDL-c,SUA,BUN,Scr,e GFR,MAU,UACR,β2-MG,NAG,PLT,RDW,NEUT,LYM,and NLR indicators were statistically significant(P<0.05).3.NLR and RDW level by quartile further divided into four groups,and the prevalence of DKD in the four groups increased sequentially,namely NLR-Q1(19.5%),NLR-Q2(45.2%),NLR-Q3(56.8%),NLRQ4(77.2%);RDW-Q1(28.9%),RDW-Q2(36.3%),RDW-Q3(59.2%),RDW-Q4(70.2%),prevalence among groups The difference in rate was statistically significant(P<0.05).4.The Pearson or Spearman correlation analysis was performed on the NLR,RDW levels and renal function indicators in the DKD group,and the results showed that NLR was positively correlated with Scr,MAU,BUN,UACR,and β2-MG(P<0.05),and negatively correlated with e GFR(P<0.05);RDW was positively correlated with Scr,MAU,β2-MG and UACR(P<0.05),and negatively correlated with e GFR(P<0.05).5.Binary Logistic regression results indicated that NLR,RDW,SUA,TG,Hb A1 c,DR medical history,SBP,age,and disease duration were positively correlated with DKD,and they were risk factors for early DKD.HDL-c is a protective factor for early DKD.6.The ROC curve was used to evaluate the value of NLR and RDW for the diagnosis of early DKD,and the results showed that the area under the curve of NLR was 0.757,the optimal threshold was 2.35,the sensitivity was 64.9%,and the specificity was 74.9%;the area under the curve of RDW was 0.717,the optimal threshold was 12.80%,the sensitivity was 70.6%,and the specificity was 62.8%;the combination of the two The area under the curve of RDW was 0.717,the sensitivity was 64.5%,and the specificity was 82.6%.Conclusion 1.The levels of NLR and RDW in peripheral blood were positively correlated with the occurrence of early DKD.With the increase of NLR and RDW,the risk of DKD increased.2.NLR and RDW have some diagnostic value for early DKD,and their combination can improve the diagnostic efficacy. |
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