Objective: To investigate the associations between neutrophil-to-lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with primary aldosteronism (PA). Methods: This study was a cross-sectional study. Consecutive patients diagnosed with PA and admitted to the Second Affiliated Hospital of Nanchang University from October 2017 to April 2022 were enrolled. General information, blood routine, renal function, and other clinical data of the patients were collected. Based on the median NLR of the enrolled patients, NLR<median was defined as low NLR. Low eGFR was defined as an eGFR<60 ml·min-1·1.73 m-2. Multiple linear regression and multivariate logistic regression models, smooth curve fitting and threshold effect exploration were used to analyze the relationship between NLR and eGFR in PA patients, and stratified analysis and interaction tests were used to evaluate potential variables that may affect the correlation between NLR and eGFR. Results: This study finally included 743 PA patients, aged (50.3±10.4) years, 42.9% (319/743) were female, and the median NLR was 2.3. After adjusting for sex, age, body mass index (BMI) and other factors, multiple linear regression analysis showed that high NLR was negatively correlated with eGFR (β=-4.9, P=0.008), and multivariate logistic regression analysis showed that high NLR was associated with low eGFR (OR=3.1, P=0.002). In the corrected smooth curve, NLR is U-shaped correlation with eGFR, and the inflection point is at NLR=3.5. When the NLR was<3.5, the eGFR decreased with the increase of NLR (corrected β=-4.7, P<0.001); When the NLR was≥3.5, the eGFR increased with the increase of NLR (corrected β=5.8, P=0.031). The results of stratified analysis showed that there was an interaction between the association of NLR and eGFR with the presence or absence of hyperlipidemia (P interaction=0.017), and the correlation between NLR and eGFR was stronger in PA patients with hyperlipidemia. Conclusion: In the PA patients, there is a U-shaped relationship between NLR and eGFR, and higher NLR is associated with lower eGFR. PA patients with elevated NLR should undergo additional screening for chronic kidney disease and receive related preventive interventions.
目的： 探讨原发性醛固酮增多症（PA）患者中性粒细胞与淋巴细胞比值（NLR）与估算肾小球滤过率（eGFR）之间的关系。 方法： 本研究为横断面研究。连续纳入2017年10月至2022年4月在南昌大学第二附属医院住院且确诊为PA的患者。收集患者的一般资料和血常规、肾功能等临床资料。依据入组患者的NLR中位数，将NLR<中位数定义为低NLR；将eGFR<60 ml·min-1·1.73 m-2定义为低eGFR。应用多元线性回归及多因素logistic回归模型、平滑曲线拟合及阈值效应探索分析PA患者中NLR与eGFR之间的关系，并使用分层分析和交互作用检验评估可能影响NLR与eGFR之间相关性的潜在变量。 结果： 最终纳入743例PA患者，年龄（50.3±10.4）岁，女性占比42.9%（319/743），NLR中位数为2.3。校正性别、年龄、体重指数（BMI）等因素后，多元线性回归分析结果显示高NLR与eGFR负相关（β=-4.9，P=0.008），多因素logistic回归分析结果显示高NLR与低eGFR相关（OR=3.1，P=0.002）。在校正后的平滑曲线中，NLR与eGFR呈U形相关，拐点位于NLR=3.5，当NLR<3.5时，eGFR随NLR的增加而降低（校正后的β=-4.7，P<0.001）；NLR≥3.5时，eGFR随NLR的增加而增加（校正后的β=5.8，P=0.031）。分层分析结果显示NLR与eGFR的关联与是否合并高脂血症存在交互作用（P交互=0.017），在合并高脂血症人群中NLR与eGFR之间的相关性更强。 结论： 在PA人群中，校正潜在的混杂因素后，NLR与eGFR呈U形相关，另一方面，高NLR与低eGFR有关。具有较高水平NLR的PA患者可能需要接受额外的慢性肾脏病筛查和预防性干预。.