中性粒细胞与淋巴细胞比值对ALT小于2倍正常值上限的慢性乙型肝炎病毒感染患者肝脏炎症的诊断价值

Diagnostic value of neutrophil-to-lymphocyte ratio (NLR) to liver inflammation in chronic hepatitis B virus infection with alanine aminotransferase less than two times of upper limits of normal

目的探讨中性粒细胞与淋巴细胞比值(NLR)评估谷丙转氨酶(ALT)<2倍正常值上限的慢性乙型肝炎病毒(HBV)感染患者肝脏炎症活动度的临床价值。方法选取117例ALT<2倍正常值上限的慢性HBV感染患者进行肝脏穿刺病理学检查,同时采用全自动生化分析仪和全血细胞分析仪分析患者外周血中ALT、谷草转氨酶(AST)、白蛋白(ALB)、中性粒细胞计数和淋巴细胞计数等指标。采用Pearson相关系数分析患者NLR比值与肝脏炎症指标的相关性。以肝脏穿刺病理学结果为"金标准",通过受试者工作特征曲线(ROC)评估NLR比值在鉴别肝脏炎症活动度≥2的慢性HBV感染患者的敏感度和特异度。结果 117例ALT<2倍正常值上限的慢性HBV感染患者中,肝脏炎症活动度分级为G0、G1、G2及G3患者所占比例分别为4.27%、45.28%、44.44%及5.12%。ALT<2倍正常值上限的慢性HBV感染患者NLR比值随着肝脏炎症活动度分级升高而逐渐增高,并分别与ALT和AST呈正相关性(r=0.307、0.349,P=0.001)。ROC曲线分析结果显示,NLR比值鉴别肝脏炎症活动度分级≥2的慢性HBV感染患者时,ROC曲线下面积为0.84,显著高于ALT和AST曲线下面积0.65和0.63,差异有统计学意义(P=0.001)。结论部分ALT<2倍正常值上限的慢性HBV感染患者肝脏存在较严重的炎症病变,NLR具有评估该部分患者肝脏炎症活动度的临床应用价值。

Objective To investigate the clinical diagnostic value of neutrophil-to-lymphocyte ratio（NLR） to liver inflammation of chronic HBV infected patients with alanine aminotransferase（ALT） less than two times of upper limits ofnormal. Methods A total of 117 patients diagnosed chronic HBV infection with ALT less than two times of upper limits of normal were enrolled to undergo liver biopsy. Blood hematology analyzer was used for blood routine examination,such as neutrophil and lymphocyte counts. The serum levels of ALT,AST,Alb were determined by automatic biochemical instrument. Pearson＇s correlation coefficient was applied to analyze the correlation between NLR and liver inflammation indexes. Taking the pathology results of liver biopsy as a gold standard,receiver operating characteristic（ROC） curve analysis was performed to estimate the sensitivity and the specificity of NLR ratio for distinguishing chronic HBV infected patients whose liver inflammation grade were 2 or above. Results Among117 cases of chronic HBV infected patients,4. 27% had liver inflammation activity grade 0,45. 28% had liver inflammation activity grade 1,44. 44% had liver inflammation activity grade 2,and 5. 12% had liver inflammation activity grade 3,respectively. NLR was increased with increasing liver inflammation grade,and was positively correlated with serum ALT and AST（r = 0. 307,0. 349,P = 0. 001）. Area under the ROC curve of NLR was 0. 84,while that of ALT and AST were 0. 65 and 0. 63. Conclusion A part of chronic HBV infected patients with ALT less than two times of upper limits of normal suffers from severe liver inflammation. As a simple and noninvasive method to assess the severity of liver inflammation,NLR may have broad clinical application prospects.