中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值与克罗恩病疾病活动度的相关性分析

Correlation analysis among NLR,PLR and activity of Crohn's disease

目的评估中性粒细胞/淋巴细胞比值(neutrophils-lymphocytes ratio,NLR)、血小板/淋巴细胞比值(platelet-lymphocytes ratio,PLR)与克罗恩病(Crohn’s disease,CD)疾病活动度的相关性,比较NLR、PLR、C反应蛋白(C-reactive protein,CRP)、血沉(erythrocyte sedimentation rate,ESR)独立及联合评价疾病活动度的效能。方法选择2014年6月至2016年6月就诊于武汉大学中南医院消化内科CD患者30例(132例次),健康对照组99名(99例次),收集纳入对象的一般临床信息及NLR、PLR、CRP、ESR等检查结果,采用简化CD活动指数(CDAI)进行疾病活动度的评分。同时前瞻性观察上述30例CD患者中20例(共49例次),观察时间为2017年1月至2017年6月,每次就诊时均需完善血常规、CRP、ESR及简化CDAI评分。结果活动期CD的NLR和PLR均高于缓解期(P<0.05)。经过受试者工作特征曲线(ROC)分析发现,NLR、PLR区分活动期CD与缓解期CD的阈值分别为3.02、238.3;灵敏度、特异度分别为67.6%、47.1%和69.5%、84.2%;曲线下面积(AUC)均小于CRP及ESR,但结合NLR与CRP或ESR后其预测效能较CRP、ESR独立预测时均有提高,当结合NLR、ESR、CRP三者预测CD活动度时,效能最高。结论 PLR、NLR均可区分活动期CD与缓解期CD,但其独立预测效能不及CRP或ESR,当CRP或ESR联合NLR预测CD活动度时,效能均较前提高,联合NLR、ESR、CRP水平,其预测CD活动度效能最高。

Objective To evaluate the correlation among NLR,PLR and the activity of Crohn＇s disease（CD）. The prediction efficiency of independent or combined with NLR,PLR,CRP,ESR on disease activity. Methods The results of NLR,PLR,CRP,ESR in 30 cases（132 clinical records） of CD patients and 99 of healthy controls were collected. The disease activity was assesed by implified CD activity index（CDAI）. Meanwhile,20 CD patients were observed prospectively from Jan. 2017 to Jun. 2017 and these patients were required to complete blood test,CRP,ESR and CDAI everytime. Results The levels of NLR,PLR were higher in active CD than those in remmision CD（P〈0. 05）. The receiver operating characteristic（ROC） analysis revealed that the optimum cut-offs of NLR and PLR were 3. 02 and 238. 3 for active CD with sensitity 67. 6%,47. 1%,specifity 69. 5%,84. 2%. The areas of NLR and PLR under the ROC curves were smaller than those in CRP and ERS. However,the AUC of the CD activity predicted by CRP or ESR combined NLR was higher than CRP or ERS alone. And the combination of CRP,ESR and NLR achieve most in the prediction efficiency of CD activity. In the prospective study,the NLR ＋ ESR ＋ CRP did the best on the accuracy of assessment of activity in CD.Conclusion PLR and NLR can both distinguish active CD from remission CD. Howerver,the independent prediction efficiency of them was less effective than CRP or ERS alone. The prediction efficiency improved when combining the level of NLR with ESR or CRP,while the unity of NLR,ESR and CRP showed best efficiency.