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外周血嗜酸性粒细胞升高对评估糖尿病肾病预后的临床价值
Prognostic value of elevated peripheral blood eosinophils for diabetic nephropathy
- 陆军军医大学学报 2024年46卷第19期 页码：2218-2224
- 作者机构：
1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院肾内科
2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院内分泌科
3.400037 重庆，陆军军医大学(第三军医大学)第二附属医院病案室
4.400038 重庆，陆军军医大学(第三军医大学)免疫研究所
5.400030 重庆，重庆国家免疫研究院
- 作者简介：
[张静波，E-mail：zhangjingbo@tmmu.edu.cn ZHANG Jingbo, E-mail: zhangjingbo@tmmu.edu.cn
- 基金信息：国家自然科学基金面上项目(82271846);重庆市科研机构绩效激励指导专项基金(cstc2021jxjl130036);重庆市国际免疫学研究所项目(2022YJC01)
DOI：10.16016/j.2097-0927.202403039
中图分类号： R446.11;R587.2;R692.07收稿：2024-03-11，
修回：2024-07-19，
纸质出版：2024-10-15
- 稿件说明：
移动端阅览
张江南, 唐莎, 王渊, 等. 外周血嗜酸性粒细胞升高对评估糖尿病肾病预后的临床价值[J]. 陆军军医大学学报, 2024,46(19):2218-2224.
Jiangnan ZHANG, Sha TANG, Yuan WANG, et al. Prognostic value of elevated peripheral blood eosinophils for diabetic nephropathy[J]. Journal of Army Medical University, 2024, 46(19): 2218-2224.
张江南, 唐莎, 王渊, 等. 外周血嗜酸性粒细胞升高对评估糖尿病肾病预后的临床价值[J]. 陆军军医大学学报, 2024,46(19):2218-2224. DOI： 10.16016/j.2097-0927.202403039.
Jiangnan ZHANG, Sha TANG, Yuan WANG, et al. Prognostic value of elevated peripheral blood eosinophils for diabetic nephropathy[J]. Journal of Army Medical University, 2024, 46(19): 2218-2224. DOI： 10.16016/j.2097-0927.202403039.
摘要
目的
2
评价外周血嗜酸性粒细胞计数(peripheral eosinophil count，PEC)在糖尿病肾病(diabetic nephropathy，DN)预后中的临床价值。
方法
2
收集2021年3月至2023年3月在我院肾内科经肾活检确诊的220例DN患者的血常规、肾功能相关指标等临床资料进行回顾性队列研究。根据X-tile 3.6.1生物信息软件计算PEC的最佳截点值；采用Cox比例风险回归模型及Kaplan-Meier生存分析肾脏预后。
结果
2
PEC水平与血肌酐(serum creatinine，Scr)(
r
=0.245)、血尿素氮(blood urea nitrogen，BUN)(
r
=0.237)和血尿酸(blood uric acid，UA)(
r
=0.252)水平呈正相关，与估算肾小球滤过率(estimated glomerular filtration rate，eGFR)(
r
=-0.236)呈负相关。根据PEC的最佳截点值(0.29×10
9
/L) 将DN患者分为高水平组(
>
0.29×10
9
/L)(
n
=41)和低水平组(≤0.29×10
9
/L)(
n
=179)。与低水平组比较，高水平PEC组患者的Scr(
P
＜0.001)、BUN(
P
=0.001)和UA(
P
=0.005)水平明显高于低水平组患者，eGFR低于低水平组患者(
P
＜0.001)。多因素Cox比例风险回归分析显示，高水平PEC与肾脏预后不良相关(
HR
=2.20，95%
CI
：1.05~4.60，
P
=0.036)；Kaplan-Meier生存分析提示，高水平PEC组患者终末期肾病(end-stage renal disease，ESRD)发生率明显高于低水平组患者(
P
=0.024)。
结论
2
PEC水平与DN的进展及预后密切相关，是预测DN预后的潜在生物标志物。
Abstract
Objective
2
To investigate the clinical value of peripheral eosinophil count (PEC) in predicting the outcome of diabetic nephropathy (DN).
Methods
2
A retrospective cohort trial was conducted on 220 DN patients identified by renal biopsy in Department of Nephrology of Second Affiliated Hospital from Army Medical University from March 2021 to March 2023. Clinical data
results of routine blood test and renal function were collected. X-tile bioinformatics software version 3.6.1 was used to determine the optimal cut-off value of PEC for predicting survival. Cox proportional hazards model and Kaplan-Meier survival analysis were applied to analyze the prognosis.
Results
2
The level of PEC in DN patients was positively correlated with the levels of serum creatinine (Scr) (
r
=0.245)
blood urea nitrogen (BUN) (
r
=0.237) and blood uric acid (UA) (
r
=0.252)
and negatively with estimated glomerular filtration rate (eGFR) (
r
=-0.236). According to the optimal PEC cut-off value
DN patients were divided into high-level group (
>
0.29×10
9
/L
n
=41) and low-level group (≤0.29×10
9
/L
n
=179). The levels of Scr (
P
<
0.001)
BUN (
P
=0.001) and UA (
P
=0.005) were significantly higher
while the eGFR (
P
<
0.001) was obviously lower in the high-level group than the low-level group. Multivariate Cox regression analysis showed that the high level of PEC was associated with poor prognosis of DN (
HR
=2.20
95%
CI
: 1.05~4.60
P
=0.036). Kaplan-Meier survival analysis demonstrated that the incidence of end-stage renal disease (ESRD) was notably higher in the high-level group than the low-level group (
P
=0.024).
Conclusion
2
PEC level of DN patients is closely associated with the progression and prognosis of DN
and the count is a potential biomarker for predicting the prognosis of DN.
关键词
Keywords
references
PHILLIPS J, CHEN J H C, OOI E, et al . Global epidemiology, health outcomes, and treatment options for patients with type 2 diabetes and kidney failure[J ] . Front Clin Diabetes Healthc, 2021, 2: 731574. DOI: 10.3389/fcdhc.2021.731574.
SHI S M, NI L H, GAO L, et al . Comparison of nonalbuminuric and albuminuric diabetic kidney disease among patients with type 2 diabetes: a systematic review and meta-analysis[J ] . Front Endocrinol, 2022, 13: 871272. DOI: 10.3389/fendo.2022.871272.
KOPEL J, PENA-HERNANDEZ C, NUGENT K. Evolving spectrum of diabetic nephropathy[J]. World J Diabetes, 2019, 10(5): 269-279. DOI: 10.4239/wjd.v10.i5.269.
LIU C B, YANG M, LI L, et al . A glimpse of inflammation and anti-inflammation therapy in diabetic kidney disease[J ] . Front Physiol, 2022, 13: 909569. DOI: 10.3389/fphys.2022.909569.
RAMIREZ G A, YACOUB M R, RIPA M, et al . Eosinophils from physiology to disease: a comprehensive review[J ] . Biomed Res Int, 2018, 2018: 9095275. DOI: 10.1155/2018/9095275.
KANDA A, YASUTAKA Y, VAN BUI D, et al . Multiple biological aspects of eosinophils in host defense, eosinophil-associated diseases, immunoregulation, and homeostasis: is their role beneficial, detrimental, regulator, or bystander?[J ] . Biol Pharm Bull, 2020, 43(1): 20-30. DOI: 10.1248/bpb.b19-00892.
HA J W, AHN S S, SONG J J, et al . Clinical implications of peripheral eosinophil count at diagnosis in patients newly diagnosed with microscopic polyangiitis and granulomatosis with polyangiitis[J ] . Arthritis Res Ther, 2023, 25(1): 245. DOI: 10.1186/s13075-023-03233-1.
CONSTANTINESCU A E, BULL C J, JONES N, et al . Circulating white blood cell traits and colorectal cancer risk: a Mendelian randomisation study[J ] . Int J Cancer, 2024, 154(1): 94-103. DOI: 10.1002/ijc.34691.
WEN W, ZHANG Z Y, SHE J Q, et al . The predictive values of white blood cell indices (lymphocyte and eosinophilic granulocyte) for heart failure in acute coronary syndrome patients following percutaneous coronary intervention: a prospective cohort study[J ] . Clin Interv Aging, 2023, 18: 951-962. DOI: 10.2147/CIA.S413313.
LEI C Y, GU J Y, LIU L L, et al . The correlation between peripheral complete blood count parameters and diabetic macular edema in proliferative diabetic retinopathy patients: a cross-sectional study[J ] . Front Endocrinol, 2023, 14: 1190239. DOI: 10.3389/fendo.2023.1190239.
KIELAR D, JONES A M, WANG X, et al . Association between elevated blood eosinophils and chronic kidney disease progression: analyses of a large United States electronic health records database[J ] . Int J Nephrol Renovasc Dis, 2023, 16: 269-280. DOI: 10.2147/IJNRD.S431375.
WHEELOCK K M, SAULNIER P J, TANAMAS S K, et al . White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in type 2 diabetes[J ] . Nephrol Dial Transplant, 2018, 33(6): 1001-1009. DOI: 10.1093/ndt/gfx231.
HATTORI K, SAKAGUCHI Y, OKA T, et al . Interstitial eosinophilic aggregates and kidney outcome in patients with CKD[J ] . Clin J Am Soc Nephrol, 2023, 18(12): 1563-1572. DOI: 10.2215/CJN.0000000000000277.
WU W Y, ZHOU X J, SUN P P, et al . Interstitial eosinophilic infiltration in diabetic nephropathy is indicative of poor prognosis, with no therapy benefit from steroid[J ] . J Diabetes, 2020, 12(12): 881-894. DOI: 10.1111/1753-0407.13077.
COHEN TERVAERT T W, MOOYAART A L, AMANN K, et al . Pathologic classification of diabetic nephropathy[J ] . J Am Soc Nephrol, 2010, 21(4): 556-563. DOI: 10.1681/ASN.2010010010.
Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease[J]. Kidney Int, 2022, 102(5s): S1-S127. DOI: 10.1016/j.kint.2022.06.008.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification[J]. Am J Kidney Dis, 2002, 39(2 Suppl 1): S1-S266.
CAMP R L, DOLLED-FILHART M, RIMM D L. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization[J]. Clin Cancer Res, 2004, 10(21): 7252-7259. DOI: 10.1158/1078-0432.CCR-04-0713.
DANG X Y, YE S G, ZHOU L L, et al . Prognostic impact of peripheral eosinophil counts in patients with diffuse large B-cell lymphoma receiving chimeric antigen receptor T-cell therapy[J ] . Cytotherapy, 2023, 25(6): 573-577. DOI: 10.1016/j.jcyt.2022.10.010.
HU W T, ZHANG Q R, ZHANG Z, et al . Eosinophil and IFN-γ associated with immune-related adverse events as prognostic markers in patients with non-small cell lung cancer treated with immunotherapy[J ] . Front Immunol, 2023, 14: 1112409. DOI: 10.3389/fimmu.2023.1112409.
GONZALEZ GOMEZ H, SAVARRAJ J P J, PAZ A S, et al . Peripheral eosinophil trends and clinical outcomes after non-traumatic subarachnoid hemorrhage[J ] . Front Neurol, 2023, 14: 1051732. DOI: 10.3389/fneur.2023.1051732.
XIU J W, WANG X L, XU W, et al . Diagnostic value of peripheral blood eosinophils for benign and malignant pulmonary nodule[J ] . Medicine, 2023, 102(44): e35936. DOI: 10.1097/MD.0000000000035936.
LIU R H, PENG Y, YE H J, et al . Peripheral eosinophil count associated with disease activity and clinical outcomes in hospitalized patients with lupus nephritis[J ] . Nephron, 2023, 147(7): 408-416. DOI: 10.1159/000528486.
ISHⅡ R, FUJITA S I, KIZAWA S, et al . Association between absolute blood eosinophil count and CKD stages among cardiac patients[J ] . Heart Vessels, 2016, 31(2): 198-205. DOI: 10.1007/s00380-014-0590-8.
TARIQ A, OKAMATO K, TARIQ A, et al . Eosinophilia and risk of incident end stage kidney disease[J ] . BMC Nephrol, 2020, 21(1): 14. DOI: 10.1186/s12882-020-1685-3.
AGARWAL R, LIGHT R P. Patterns and prognostic value of total and differential leukocyte count in chronic kidney disease[J]. Clin J Am Soc Nephrol, 2011, 6(6): 1393-1399. DOI: 10.2215/CJN.10521110.
ARAÚJO L S, TORQUATO B G S, DA SILVA C A, et al . Renal expression of cytokines and chemokines in diabetic nephropathy[J ] . BMC Nephrol, 2020, 21(1): 308. D OI: 10.1186/s12882-020-01960-0.
GIGON L, FETTRELET T, YOUSEFI S, et al . Eosinophils from A to Z[J ] . Allergy, 2023, 78(7): 1810-1846. DOI: 10.1111/all.15751.
SELBY N M, TAAL M W. An updated overview of diabetic nephropathy: diagnosis, prognosis, treatment goals and latest guidelines[J]. Diabetes Obes Metab, 2020, 22(Suppl 1): 3-15. DOI: 10.1111/dom.14007.
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