红细胞分布宽度及平均血小板体积对自身免疫性肝炎肝硬化的预测与诊断价值

Predictive and diagnostic value of red blood cell distribution width and mean platelet volume in autoimmune hepatitis related cirrhosis

目的评价炎症相关指标对自身免疫性肝炎(AIH)肝硬化的预测及诊断价值。方法分析111例AIH患者基于血常规检测的炎症相关指标水平,包括红细胞分布宽度(RDW)、平均血小板体积(MPV)、血小板分布宽度(PDW)、中性粒细胞-淋巴细胞比值(NLR)、淋巴-单核细胞比值(LMR)、血小板-淋巴细胞比值(PLR)。采用二元logistic回归分析上述各指标与AIH肝硬化的相关性,受试者工作特征(ROC)曲线评价各指标对AIH肝硬化的诊断价值。结果 AIH患者肝功能指标总蛋白(TP)、白蛋白(ALB)、谷草转氨酶(AST)及谷丙转氨酶(ALT)异常,且AIH肝硬化和慢性AIH组间差异均有统计学意义(P<0.05)。AIH肝硬化患者RDW、MPV及NLR明显升高(P<0.05),分别为15.75%(14.20%～17.60%)、(11.75±1.30)f L和2.60(1.76～3.94)。经logistic回归分析证实,RDW和MPV是AIH肝硬化的独立危险因素,OR(95%CI)分别为1.349(1.128～1.614)和1.465(1.044～2.056),两者诊断AIH肝硬化的ROC曲线下面积(AUC)分别为0.736和0.675。结论 RDW和MPV水平升高与AIH肝硬化发生相关,对AIH病程监测具有一定价值。

Objective To assess the clinical significance of red blood cell distribution width(RDW),mean platelet volume(MPV),platelet distribution width(PDW),neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR)and platelet to lymphocyte ratio(PLR)in predicting cirrhosis in Chinese patients with autoimmune hepatitis(AIH).Methods Peripheral blood cell analysis was conducted in 111 AIH patients to calculate these inflammatory markers based on blood cell count.Binary logistic regression analysis was performed to analyze the risk factors of liver cirrhosis and receiver operating characteristic(ROC)curve was conducted to evaluate the diagnostic value of each index in identifying cirrhosis patients from chronic patients with AIH.Results Serum levels of indicators reflecting liver function including total protein,albumin,aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were abnormal in patients with AIH,and there was a significant difference between AIH cirrhosis group and chronic AIH group(P<0.05).Inflammatory indices based on blood cell analysis including RDW,MPV and NLR were 15.75%(14.20%-17.60%),(11.75±1.30)f L and 2.60(1.76-3.94)respectively in AIH patients with cirrhosis,elevated remarkably compared to chronic AIH patients.Binary logistic regression analysis showed that RDW and MPV were identified to be independent risk factors of cirrhosis with OR(95%CI)of 1.349(1.128-1.614)and 1.465(1.044-2.056)respectively;ROC analysis showed that the areas under the ROC cur ve(AUC)of RDW and MPV were 0.736 and 0.675 respectively.Conclusion RDW and MPV were independent risk factors associated with AIH cirrhosis and can serve as reference indices to monitor disease course in AIH.