The clinical application study of platelet to lymphocyte ratio in type 2 diabetes-induced renal impairment in elderly patients

Abstract

Objective To explore the relationship between platelet to lymphocyte ratio(PLR)and the severity of renal impairment in elderly patients with type 2 diabetes mellitus(T2DM). Methods Two hundred elderly T2DM patients treated in our department of endocrinology from January 2017 to January 2018 included 100 cases with diabetic nephropathy(DN group)and 100 without nephropathy(control DM group), and 100 individuals undergoing physical healthy examination during the same period(normal control group)were retrospectively enrolled.DN group included 50 early, 27 medium and 23 end stage patients.Albumin to globulin ratio(A/G), hemoglobin A1c(HbA1c), urea nitrogen(BUN), serum creatinine(Scr), estimated glomerular filtration rate(eGFR), 24-hour urine protein quantification(24h-UTP), neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR), etc.were collected and compared among DN group, control DM group and normal control group.Binary Logistic regression analyses were performed to predict whether elderly patients with T2DM progress to DN.Correlations between PLR and HbA1c were analyzed using Spearman correlation coefficient. Results The BMI, waist circumference, waist-hip ratio, systolic blood pressure, disease duration, A/G, Scr, BUN, eGFR, 24 h-UTP, interleukin 6(IL-6), hypersensitive C-reactive protein(hs-CRP), PLR, and NLR showed statistically significant differences among three groups(all P<0.05). The differences in A/G, Scr, BUN, eGFR, 24h-UTP, hs-CRP, PLR, and NLR between early, medium and end phases of DN were statistically significant(all P<0.05). The predictors for the progression to diabetic nephropathy were the levels of A/G(OR: 1.12, 95%CI: 0.89-1.65), Scr(OR: 200.34, 95%CI: 65.28-412.36), BUN(OR: 10.26, 95%CI: 8.34-16.94), eGFR(OR: 85.37, 95%CI: 78.31-103.57), 24h-UTP(OR: 187.32, 95%CI: 142.92-1523.49), PLR(OR: 81.51, 95%CI: 78.45-132.68), NLR(OR: 1.20, 95%CI: 1.07-3.57), IL-6(OR: 4.25, 95%CI: 3.76-9.31), and hs-CRP(OR: 3.41, 95%CI: 2.35-10.51)in T2DM patients.There were significant correlations of PLR with A/G, Scr, BUN, eGFR, 24-UTP, NLR, IL-6, and hs-CRP(r=-0.338, 0.469, 0.521, -0.457, 0.463, 0.642, 0.297, 0.448, all P<0.05). Conclusions PLR, which is inexpensive and easy to measure, can predict the risk of progressing to DN in elderly T2DM patients and may evaluate their renal function, and is worth extending in clinical practice. Key words: Blood platelet; Lymphocytes; Diabetes, type 2; Diabetic nephropathies