血小板与淋巴细胞比值对溃疡性结肠炎鉴别诊断及其严重程度判定的临床意义分析

Clinical significance of platelet/lymphocyte ratio in the differentiation and severity determination of ulcerative colitis

目的评估血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)对溃疡性结肠炎的临床应用价值。方法选取2009年6月至2016年6月于上海长海医院就诊的192例患者,其中溃疡性结肠炎97例,肠易激综合征95例,分析2组患者PLR差异,并评价PLR对溃疡性结肠炎诊断的敏感性、特异性;通过改良的Mayo评分系统评估溃疡性结肠炎疾病活动度,结肠镜确定病变蔓延部位,评估PLR与疾病活动度及病变蔓延部位的相关性。结果与肠易激综合征对照组相比,溃疡性结肠炎患者白细胞计数、血小板计数、PLR、红细胞沉降率、C反应蛋白显著增高,血红蛋白显著降低,差异具有统计学意义(P<0.05)。PLR在溃疡性结肠炎与肠易激综合征组间差异有统计学意义,通过受试者工作曲线(receiver operating characteristic curve,ROC)分析,PLR检测的敏感度和特异度分别为67%和58%。肠易激综合征和轻、中、重度溃疡性结肠炎的PLR分别是123.73±60.47、114.32±43.66、160.19±56.52、253.35±86.82。肠易激综合征PLR与轻度溃疡性结肠炎PLR比较差异无统计学意义(P=0.54),与中、重度溃疡性结肠炎PLR比较差异均有统计学意义(P<0.05);轻、中、重度溃疡性结肠炎PLR比较差异均有统计学意义(P<0.05)。PLR在溃疡性结肠炎不同病变蔓延部位之间差异无统计学意义(P>0.05)。结论 PLR在溃疡性结肠炎与肠易激综合征鉴别诊断中具有一定价值和临床意义,并且可以判断溃疡性结肠炎的活动度。

Objective To evaluate clinical significance of platelet/lymphocyte ratio（PLR） in the differentiation and severity determination of ulcerative colitis. Methods One hundred and ninety-two patients who sought medical care from June 2009 to June2016,in Changhai Hospital,were enrolled as study subjects,of whom 97 were patients with ulcerative colitis and 95 were patients with irritable bowel syndrome. Differences in PLR between the 2 groups were analyzed and the sensitivity and specificity of PLR in the diagnosis of ulcerative colitis were also evaluated. Through the modified Mayo score system,the activity of ulcerative colitis was evaluated,and pathological spreading site was determined by colonoscopy,and the correlation between PLR and disease activity and pathological spreading site was evaluated. Results As compared with those of the control group with irritable bowel syndrome,the while blood cell counts,blood platelet counts,PLR,the erythrocyte sedimentation rate and the C-reaction protein of the patients with ulcerative colitis were significantly increased,and statistical significance could be noted when comparisons were made between them（P〈0. 05）. Statistical significance could be found in PLR differences between the ulcerative colitis patients and irritable bowel syndrome patients. ROC analysis indicated that sensitivity and specificity of the PLR biomarker were respectively 67% and 58%. PLR data for the patients with irritable bowel syndrome and those with light,moderate and severe ulcerative colitis were 123. 73 ± 60. 47,114. 32 ± 43. 66,160. 19 ±56. 52 and 253. 35 ± 86. 82 respectively. Results indicated that there was no statistical significance in the clinical data between irritable bowel syndrome and light ulcerative colitis（P = 0. 54）. However,statistical significance could be noted in the data between irritable bowel syndrome and moderate/severe ulcerative colitis（P〈0. 05）. Statistical significance could all be seen in the differences of the clinical data between light,moderate and severe ulcerative colitis（P〈0. 05）. But there was no statistical difference in PLR between different pathological lesions in the patients with ulcerative colitis（P〈0. 05）. Conclusion PLR has certain clinical value and significance in the identification and diagnosis of ulcerative colitis and irritable bowel syndrome,and at the same time,it could evaluate the degree of inflammation of ulcerative colitis.