中性粒细胞与淋巴细胞比值在结节病中的运用

application of neutrophil to lymphocyte ratio in patients with sarcoidosis

目的探讨中性粒细胞与淋巴细胞比值（NLR）在结节病诊断及病情评估中的应用价值。方法选取41例结节病患者作为研究组,并依据胸部影像学分期分为0-Ⅰ期组（A组）和Ⅱ-Ⅲ期组（B组）;另选取健康体检者41例作为对照组。搜集3组的临床资料及相关实验室检查数据包括中性粒细胞数、淋巴细胞数、NLR、血小板平均体积（MPV）、红细胞分布宽度（RDW）、血沉（ESR）、血清血管紧张素转化酶（SACE）等,比较各组间的差异,并运用统计学软件画立受试者工作特征曲线（ROC曲线）,以尝试确定NLR值助于诊断结节病的最佳截点。结果研究组的NLR、ESR水平均高于对照组（P均〈0.05）;B组NLR水平高于A组（P〈0.05）;画NLR水平预测结节病的诊断ROC工作曲线,当最佳截点NLR=2.25时,其约登指数最大（0.629）,曲线下面积为0.864,可信区间（78.5,94.3）,其诊断结节病的敏感度为82.9%,特异度为80.0%;随着结节病患者分期的增加,其NLR有随之升高的趋势,NLR≥2.25的人数也相应增加,且NLR越高的患者,其咳嗽、呼吸困难、肺外器官的受累也较为常见。结论 NLR可能是一种与结节病的诊断、病情严重度相关的独立炎症指标,NLR越高预示病情分期越高,临床表现及肺外侵犯越多,为结节病的诊断、病情评估、是否需要治疗提供了一定的理论参考。

Objective It is to explore the application value of neutrophil to lymphocyte ratio in the diagnosis and prognosis assessment of sarcoidosis. Methods 41 cases of sarcoidosis patients were selected as research group,and on the basis of the chest radiological staging,the 0 to Ⅰ stage were divided into group A,Ⅱ to stage Ⅲ was divided into group B,41 cases of healthy people were selected as control group. The clinical data of the study group and control group,and related laboratory examination data such as the number of neutrophil,lymphocyte count,neutrophil to lymphocyte ratio（ NLR）,mean platelet volume（ MPV）,red cell distribution width（ RDW）,erythrocyte sedimentation rate（ ESR）,serum angiotensin converting enzyme（ SACE） and so on were collected,the differences between the study group and the control group,group A and group B were compared,and the statistical software made by receiver operating characteristic curve（ ROC curve） was made in an attempt to determine the NLR value of optimal cut-off contributes to the diagnosis of sarcoidosis. Results The NLR,ESR levels were higher in the study group than those in the control group（ P 0. 05）; The level of NLR in group B was higher than that in group A（ P 0. 05）; ROC curve drawing vertical NLR levels for predicting the diagnosis of sarcoidosis,when the optimal cut-off point of NLR = 2. 25,the largest Youden index（ 0. 629）,the area under the curve was 0. 864（ 78. 5 confidence interval,94. 3）,the sensitivity of the diagnostic node disease was 82. 9%,specificity was 80%; With sarcoidosis stages of the patients increased,the levels of NLR had a increasing trend,the quality of the patients with NLR that was more than or equal to2. 25 also increased,the cough,dyspnoea,extrapulmonary organ involvement also more common in the patients with higher levels of NLR. Conclusion NLR may be an independent inflammation index which is related with the diagnosis,and severity of sarcoidosis,higher NLR levels predicted higher staging,possible violations of clinical manifestations and extrapulmonary involvement,this provides some theoretical reference for the diagnosis,condition evaluation,whether to need treatment of sarcoidosis.