钱建平,罗朋立

全血细胞计数是临床医生要求的最常见的血液检查之一，可评估血液中细胞成分的计数和特征，主要包括：（1）白细胞总数和分类计数；（2）红细胞图；（3）血小板计数及计算指标等。此外，全血细胞计数中某些成分的组合，例如中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率和血小板与白细胞比率在之前的研究中已经进行了探讨。随着外周血中未成熟细胞自动计数的出现，全血细胞计数成为临床监测中非常重要的工具。本篇综述的主要目的是阐述全血细胞计数及相关参数在肾脏疾病中的诊断和预后价值，以了解其在临床决策中的重要性，改善这些疾病的管理。

全血细胞计数；肾脏疾病；病理生理

[1] Munoz Mendoza J,Isakova T,Cai X,et al.Inflammation and elevated levels of fibroblast growth factor 23 are independent risk factors for death in chronic kidney disease[J].Kidney International,2017,91(3):711-719. [2] Erlinger T P,Tarver-Carr M E,Powe N R,et al.Leukocytosis,hypoalbuminemia,and the risk for chronic kidney disease in US adults[J]. American Journal of Kidney Diseases,2003,42(2):256-263. [3] Fan F,Jia J,Li J,et al.White blood cell count predicts the odds of kidney function decline in a Chinese community-based population[J]. BMC nephrology,2017,18(1):190. [4] Shankar A,Sun L,Klein B E K,et al.Markers of inflammation predict the long-term risk of developing chronic kidney disease:a population-based cohort study[J].Kidney International,2011,80(11):1231-1238. [5] Song M,Graubard B I,Rabkin C S,et al.Neutrophil-to-lymphocyte ratio and mortality in the United States general population[J]. Scientific Reports,2021,11(1):464. [6] Sevencan N O,Ozkan A E.Associations between neutrophil/lymphocyte ratio,platelet/lymphocyte ratio,albuminuria and uric acid and the estimated glomerular filtration rate in hypertensive patients with chronic kidney disease stages 1–3[J].Archives of Medical Science :AMS,2019,15(5):1232-1239. [7] Proctor M J,McMillan D C,Morrison D S,et al.A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer[J].British Journal of Cancer,2012,107(4):695-699. [8] Templeton A J,McNamara M G,Šeruga B,et al.Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors:a systematic review and meta-analysis[J].Journal of the National Cancer Institute,2014,106(6):dju124. [9] Li P,Xia C,Liu P,et al.Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease(ESRD)[J].Bmc Nephrology,2020,21(1):511. [10] Catabay C,Obi Y,Streja E,et al.Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients[J].American journal of nephrology,2017,46(5):408-416. [11] Yuan Q,Wang J,Peng Z,et al.Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in chinese patients with chronic kidney disease:results from the chinese cohort study of chronic kidney disease(C-STRIDE)[J].Journal of Translational Medicine, 2019,17(1):86. [12] Tsai S F,Wu M J,Chen C H.Low serum C3 level,high neutrophil-lymphocyte-ratio,and high platelet-lymphocyte-ratio all predicted poor long-term renal survivals in biopsy-confirmed idiopathic membranous nephropathy[J].Scientific Reports,2019,9(1):6209. [13] Tatar E,Mirili C,Isikyakar T,et al.The association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease[J].Acta Clinica Belgica,2016,71(4):221-226. [14] Nierhaus A,Klatte S,Linssen J,et al.Revisiting the white blood cell count:immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis--a prospective,observational study[J].BMC immunology,2013,14:8. [15] Karakulak S,NarcıH,Ayrık C,et al.The prognostic value of immature granulocyte in patients with acute pancreatitis[J].The American Journal of Emergency Medicine,2021,44:203-207. [16] Wettin N,Drogies T,Kühnapfel A,et al.Automated Complete Blood Cell Count Using Sysmex XN-9000®in the Diagnosis of Newborn Infection[J].Journal of Clinical Medicine,2022,11(19):5507. [17] Daix T,Guerin E,Tavernier E,et al.Multicentric Standardized Flow Cytometry Routine Assessment of Patients With Sepsis to Predict Clinical Worsening[J].Chest,2018,154(3):617-627. [18] Goag E K,Lee J W,Roh Y H,et al.A Simplified Mortality Score Using Delta Neutrophil Index and the Thrombotic Microangiopathy Score for Prognostication in Critically Ill Patients[J].Shock,2018,49(1):39. [19] Cetın N,Kocaturk E,Tufan A K,et al.Immature granulocytes as biomarkers of inflammation in children with predialysis chronic kidney disease[J].Pediatric Nephrology(Berlin,Germany),2023,38(1):219-225. [20] YazılıtaşF,KargınÇakıcıE,Karakaya D,et al.Evaluation of immature granulocyte percentage and count in pediatric nephrotic syndrome[J].Postgraduate Medicine,2024,136(1):36-43. [21] 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].Nephrology,Dialysis,Transplantation:Official Publication of the European Dialysis and Transplant Association-European Renal Association,2018,33(6):1001-1009. [22] Dai D F,Sasaki K,Lin M Y,et al.Interstitial eosinophilic aggregates in diabetic nephropathy:allergy or not?[J].Nephrology,Dialysis, Transplantation:Official Publication of the European Dialysis and Transplant Association-European Renal Association,2015, 30(8):1370-1376. [23] Shiva S,Rassaf T,Patel R P,et al.The detection of the nitrite reductase and NO-generating properties of haemoglobin by mitochondrial inhibition[J].Cardiovascular Research,2011,89(3):566-573. [24] Yamanouchi M,Furuichi K,Shimizu M,et al.Serum hemoglobin concentration and risk of renal function decline in early stages of diabetic kidney disease:a nationwide,biopsy-based cohort study[J].Nephrology Dialysis Transplantation,2022,37(3):489-497. [25] Kawai K,Ishii M,Kokado Y,et al.Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD[J].Kidney International Reports,2024,9(7):2056-2066. [26] Zhang T,Li J,Lin Y,et al.Association Between Red Blood Cell Distribution Width and All-cause Mortality in Chronic Kidney Disease Patients:A Systematic Review and Meta-analysis[J].Archives of Medical Research,2017,48(4):378-385. [27] Vashistha T,Streja E,Molnar M Z,et al.Red Cell Distribution Width and Mortality in Hemodialysis Patients[J].American Journal of Kidney Diseases:The Official Journal of the National Kidney Foundation,2016,68(1):110-121. [28] Peng F,Li Z,Zhong Z,et al.An increasing of red blood cell distribution width was associated with cardiovascular mortality in patients on peritoneal dialysis[J].International Journal of Cardiology,2014,176(3):1379-1381. [29] Koupenova M,Clancy L,Corkrey H A,et al.Circulating Platelets as Mediators of Immunity,Inflammation,and Thrombosis[J]. Circulation Research,2018,122(2):337-351. [30] Puertas M,Zayas-Castro J L,Fabri P J.Statistical and prognostic analysis of dynamic changes of platelet count in ICU patients[J]. Physiological Measurement,2015,36(5):939-953. [31] Pinna A,Carlino P,Serra R,et al.Red Cell Distribution Width(RDW)and Complete Blood Cell Count-Derived Measures in Non- Arteritic Anterior Ischemic Optic Neuropathy[J].International Journal of Medical Sciences,2021,18(10):2239-2244. [32] Park B J,Shim J Y,Lee H R,et al.The relationship of platelet count,mean platelet volume with metabolic syndrome according to the criteria of the American Association of Clinical Endocrinologists:a focus on gender differences[J].Platelets,2012,23(1):45-50. [33] Yang K,Du C,Wang X,et al.Indoxyl sulfate induces platelet hyperactivity and contributes to chronic kidney disease-associated thrombosis in mice[J].Blood,2017,129(19):2667-2679. [34] G L,M S,M P,et al.Mean platelet volume predicts vascular access events in hemodialysis patients[J].Journal of clinical medicine, 2019,8(5). [35] Catanzaro R,Sciuto M,Lanzafame C,et al.Platelet to lymphocyte ratio as a predictive biomarker of liver fibrosis(on elastography)in patients with hepatitis C virus(HCV)-related liver disease[J].Indian Journal of Gastroenterology:Official Journal of the Indian Society of Gastroenterology,2020,39(3):253-260. [36] Kumarasamy C,Tiwary V,Sunil K,et al.Prognostic Utility of Platelet-Lymphocyte Ratio,Neutrophil-Lymphocyte Ratio and Monocyte- Lymphocyte Ratio in Head and Neck Cancers:A Detailed PRISMA Compliant Systematic Review and Meta-Analysis[J].Cancers, 2021,13(16):4166. [37] Gan W,Guan Q,Hu X,et al.The association between platelet-lymphocyte ratio and the risk of all-cause mortality in chronic kidney disease:a systematic review and meta-analysis[J].International Urology and Nephrology,2022,54(11):2959-2967. [38] Binnetoğlu E,Şengül E,HalhallıG,et al.Is neutrophil lymphocyte ratio an indicator for proteinuria in chronic kidney disease?[J].Journal of Clinical Laboratory Analysis,2014,28(6):487-492. [39] Li Q,Chen P,Shi S,et al.Neutrophil-to-lymphocyte ratio as an independent inflammatory indicator of poor prognosis in IgA nephropathy[J].International Immunopharmacology,2020,87:106811. [40] Duan S,Sun L,Zhang C,et al.Association of platelet-to-lymphocyte ratio with kidney clinicopathologic features and renal outcomes in patients with diabetic kidney disease[J].International Immunopharmacology,2021,93:107413. [41] Rayego-Mateos S,Morgado-Pascual J L,Opazo-Ríos L,et al.Pathogenic Pathways and Therapeutic Approaches Targeting Inflammation in Diabetic Nephropathy[J].International Journal of Molecular Sciences,2020,21(11):3798. [42] Yuan Q,Tang B,Zhang C.Signaling pathways of chronic kidney diseases,implications for therapeutics[J].Signal Transduction and Targeted Therapy,2022,7(1):182. [43] Sato Y,Mii A,Hamazaki Y,et al.Heterogeneous fibroblasts underlie age-dependent tertiary lymphoid tissues in the kidney[J].JCI insight,2016,1(11):e87680. [44] Bartnicki P.Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors as a New Treatment Option for Anemia in Chronic Kidney Disease[J].Biomedicines,2024,12(8):1884. [45] Ueda N,Takasawa K.Impact of Inflammation on Ferritin,Hepcidin and the Management of Iron Deficiency Anemia in Chronic Kidney Disease[J].Nutrients,2018,10(9):1173. [46] Mandel J,Casari M,Stepanyan M,et al.Beyond Hemostasis:Platelet Innate Immune Interactions and Thromboinflammation[J]. International Journal of Molecular Sciences,2022,23(7):3868. [47] Papayannopoulos V.Neutrophil extracellular traps in immunity and disease[J].Nature Reviews Immunology,2018,18(2):134-147. [48] Wang N,Tall A R.Cholesterol in platelet biogenesis and activation[J].Blood,2016,127(16):1949-1953.

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