外周血单核细胞计数对判断溃疡性结肠炎严重程度的意义

Significance of peripheral blood monocytes count in judging the severity of ulcerative colitis

目的评估外周血单核细胞计数对判断溃疡性结肠炎(UC)严重程度的临床价值。方法选取2015-01~2017-07于南京医科大学附属淮安第一医院住院就诊的UC患者为研究对象,共纳入306例不同严重程度的UC患者。依据Truelove-Witt标准,将所有研究对象分为轻度和中重度UC两组,其中轻度UC为157例,中重度UC为149例。回顾性分析患者外周血白细胞总数、中性粒细胞计数、淋巴细胞计数、单核细胞计数的浓度差异,评价这些指标与UC严重程度的相关性,并分析单核细胞计数对判断中重度UC的敏感性和特异性。结果轻度UC和中重度UC患者的年龄、性别、病程差异无统计学意义。中重度UC患者的血沉(ESR)和C反应蛋白(CRP)显著高于轻度UC,而这两组患者的白细胞总数、中性粒细胞计数以及淋巴细胞计数均差异无统计学意义。与轻度UC相比,中重度UC患者的单核细胞计数显著增高,差异具有统计学意义(P<0.05)。受试者工作曲线(ROC)分析示单核细胞计数检测的曲线下面积为0.610。当最佳临界值为0.395时,其判断中重度UC的敏感度和特异度分别为45.6%和75.8%。当ESR、单核细胞计数和CRP三者的乘积取值为36.561时,判断其为中重度UC的敏感度和特异度分别为48.7%和92.8%。Logistic回归分析发现,对于单核细胞计数超过正常高值(0.8×109/L)的UC患者,判断其为中重度UC的风险是轻度UC的3.915倍,差异有统计学意义(P=0.009)。结论与轻度UC相比,单核细胞计数在中重度UC患者外周血中显著升高。单核细胞计数对判断UC严重程度有一定参考价值。

Objective To evaluate the significance of peripheral blood monocytes count in judging the severity of ulcerative colitis（ UC）. Methods A total of 306 patients with different severity of UC in Huai＇an First People＇s Hospital,Nanjing Medical University from January 2015 to July 2017 were enrolled. According to the Truelove-Witts criteria,all patients were divided into two groups：mild UC group（ n = 157） and moderate to severe UC group（ n = 149）. The concentration of peripheral leukocytes,neutrophils,lymphocyte and monocytes were collected retrospectively and compared. The correlation between these factors and the severity of UC was evaluated. The sensitivity and specificity of monocytes count to judge the moderate to severe UC were also analyzed. Results There was no significant difference between mild UC and moderate to severe UC in terms of age,sex and duration. The erythrocyte sedimentation rate（ ESR） and C reactive protein（ CRP） level in patients with moderate to severe UC were significantly higher than those of mild UC,but there was no significant difference in white blood cells,neutrophils and lymphocyte counts between the two groups. Compared with mild UC,monocytes count increased significantly in patients with moderate to severe UC and the difference was statistically significant（ P〈0. 05）. The receiver operating curve（ ROC） analysis showed that the area under the curve of monocytes count for moderate to severe UC was 0. 610. When the best critical value was 0. 395,the sensitivity and specificity for judging moderate and severe UC were45. 6% and 75. 8%,respectively. When the product of ESR,monocytes count and CRP were 36. 561,the sensitivity and specificity were 48. 7% and 92. 8%,respectively. Logistic regression analysis showed that the risk of judging moderate to severe UC was 3. 915 times in UC patients with the monocytes count more than 0. 8 × 109/L compared with the patients with monocytes count under the normal high value,and the difference was statistically significant（ P = 0. 009）. Conclusion Compared with mild UC,monocytes counts increases significantly in peripheral blood of patients with moderate to severe UC. Monocytes count is valuable in judging the severity of UC.