PDF(Pubmed)
Abstract：
OBJECTIVE: Cardiac autonomic neuropathy (CAN) is one of the most serious complications of diabetes. This study aimed to analyze the correlation between neutrophil-to-lymphocyte ratio (NLR) and CAN in patients with type 2 diabetes (T2D) using 24-hour Holter ECG and to assess the relationship between NLR and severity of diabetic peripheral neuropathy (DPN).
METHODS: This cross-sectional study included 90 T2D patients with DPN confirmed by nerve conduction study (NCS). A 24-hour Holter ECG was done to detect the decrease in heart rate variability (HRV). Laboratory parameters, including fasting blood glucose, creatinine, cholesterol, triglyceride, and glycosylated hemoglobin (HbA1c) levels, as well as CBC, neutrophils, lymphocytes, NLR, and platelet-to-lymphocyte ratio (PLR), were calculated accordingly. An albumin-to-creatinine ratio (ACR) test was done and the estimated glomerular filtration rate (eGFR) was calculated. Chronic kidney disease was diagnosed by the presence of albuminuria (≥30 mg/g creatinine) and/or eGFR less than 60.
RESULTS: Based on the 24-hour Holter ECG, 25 patients out of 90 (27.7%) had CAN. On comparing both the CAN and non-CAN groups, the CAN group had higher HbA1C (p = 0.005), higher NLR (p = 0.014), and higher neutrophils (p = 0.10). Also, PLR was higher in the CAN group than in the non-CAN group, but this was not statistically significant (p = 0.180). Receiver operator characteristic curve analysis revealed that NLR with a cutoff of 1.7 succeeded in detecting patients with CAN.
CONCLUSIONS: NLR can be used as an inexpensive and accessible marker to detect patients with diabetes at risk for developing CAN.
METHODS: This cross-sectional study included 90 T2D patients with DPN confirmed by nerve conduction study (NCS). A 24-hour Holter ECG was done to detect the decrease in heart rate variability (HRV). Laboratory parameters, including fasting blood glucose, creatinine, cholesterol, triglyceride, and glycosylated hemoglobin (HbA1c) levels, as well as CBC, neutrophils, lymphocytes, NLR, and platelet-to-lymphocyte ratio (PLR), were calculated accordingly. An albumin-to-creatinine ratio (ACR) test was done and the estimated glomerular filtration rate (eGFR) was calculated. Chronic kidney disease was diagnosed by the presence of albuminuria (≥30 mg/g creatinine) and/or eGFR less than 60.
RESULTS: Based on the 24-hour Holter ECG, 25 patients out of 90 (27.7%) had CAN. On comparing both the CAN and non-CAN groups, the CAN group had higher HbA1C (p = 0.005), higher NLR (p = 0.014), and higher neutrophils (p = 0.10). Also, PLR was higher in the CAN group than in the non-CAN group, but this was not statistically significant (p = 0.180). Receiver operator characteristic curve analysis revealed that NLR with a cutoff of 1.7 succeeded in detecting patients with CAN.
CONCLUSIONS: NLR can be used as an inexpensive and accessible marker to detect patients with diabetes at risk for developing CAN.
摘要：
目的：心脏自主神经病变（CAN）是糖尿病最严重的并发症之一。本研究采用24小时动态心电图分析2型糖尿病（T2D）患者中性粒细胞与淋巴细胞比值（NLR）与CAN的相关性，评估NLR与糖尿病周围神经病变（DPN）严重程度的关系。
方法：本横断面研究纳入了经神经传导研究（NCS）证实的90例DPN患者。进行24小时动态心电图以检测心率变异性（HRV）的降低。实验室参数,包括空腹血糖,肌酐,胆固醇,甘油三酯，糖化血红蛋白（HbA1c）水平，以及CBC，中性粒细胞，淋巴细胞，NLR,和血小板淋巴细胞比率（PLR），进行了相应的计算。进行白蛋白-肌酐比（ACR）测试，并计算估计的肾小球滤过率（eGFR）。通过存在蛋白尿（≥30mg/g肌酐）和/或eGFR小于60来诊断慢性肾脏疾病。
结果：根据24小时动态心电图，90例患者中有25例（27.7％）患有CAN。在比较CAN和非CAN组时，CAN组有较高的HbA1C（p=0.005），较高的NLR(p=0.014)，和更高的中性粒细胞（p=0.10）。此外，CAN组PLR高于非CAN组,但这没有统计学意义(p=0.180).接收器操作员特征曲线分析显示，截止值为1.7的NLR成功检测到CAN患者。
结论：NLR可用作一种廉价且易于获得的标志物，用于检测有发生CAN风险的糖尿病患者。
方法：本横断面研究纳入了经神经传导研究（NCS）证实的90例DPN患者。进行24小时动态心电图以检测心率变异性（HRV）的降低。实验室参数,包括空腹血糖,肌酐,胆固醇,甘油三酯，糖化血红蛋白（HbA1c）水平，以及CBC，中性粒细胞，淋巴细胞，NLR,和血小板淋巴细胞比率（PLR），进行了相应的计算。进行白蛋白-肌酐比（ACR）测试，并计算估计的肾小球滤过率（eGFR）。通过存在蛋白尿（≥30mg/g肌酐）和/或eGFR小于60来诊断慢性肾脏疾病。
结果：根据24小时动态心电图，90例患者中有25例（27.7％）患有CAN。在比较CAN和非CAN组时，CAN组有较高的HbA1C（p=0.005），较高的NLR(p=0.014)，和更高的中性粒细胞（p=0.10）。此外，CAN组PLR高于非CAN组,但这没有统计学意义(p=0.180).接收器操作员特征曲线分析显示，截止值为1.7的NLR成功检测到CAN患者。
结论：NLR可用作一种廉价且易于获得的标志物，用于检测有发生CAN风险的糖尿病患者。
