NLR联合hs-CRP在预测甲氨蝶呤治疗中-重度斑块型银屑病患者临床疗效中的价值

Value of NLR Combined with hs-CRP in Predicting Clinical Efficacy of Methotrexate in Patients with Moderate to Severe Plaque Psoriasis

目的探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合超敏C反应蛋白(high sensitive C reaction protein,hs-CRP)在预测甲氨蝶呤(methotrexate,MTX)治疗中-重度斑块型银屑病患者临床疗效中的效能。方法回顾性纳入皮肤科门诊及住院的62例中-重度斑块型银屑病患者和45例健康对照组作为研究对象。中-重度斑块型银屑病患者在采用MTX系统性治疗16周后 PASI评分降低75%以上设为应答者(n=49),其余设为非应答者(n=13)。记录并比较中-重度斑块型银屑病患者治疗前和健康对照组的血常规参数和hs-CRP水平的差异,采用Pearson相关分析分析治疗前中-重度斑块型银屑病患者PASI评分与上述指标的相关性;比较血常规参数、hs-CRP及银屑病临床特征等参数在应答者和无应答者中的差异并采用Logistic回归分析无应答者的影响因素;利用受试者操作特征(receiver operating characteristic,ROC)曲线探讨NLR联合hs-CRP预测无应答者的临床效能。结果中-重度斑块型银屑病患者治疗前WBC、N、NLR、hs-CRP和PASI评分显著高于治疗后,差异均具有统计学意义;L、PLT、PDW、RDW在治疗前、治疗后及对照组间差异无统计学意义;Pearson相关分析显示治疗前中-重度斑块型银屑病患者PASI评分与WBC、N、NLR和hs-CRP存在显著正相关性;Logistic 回归分析结果显示NLR和hs-CRP是无应答者的影响因素。ROC曲线显示NLR联合hs-CRP预测无应答者的临床效能较高,敏感度为98.42%,特异性为75.31%。结论 NLR联合hs-CRP对MTX治疗中-重度斑块型银屑病患者的临床疗效具有一定的预测价值,临床医生可常规检查NLR和hs-CRP水平。

Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)combined with high sensitive C-reactive protein(hs-CRP)in predicting the clinical efficacy of methotrexate(MTX)in the treatment of moderate to severe plaque psoriasis.Methods A total of 62 patients with moderate to severe plaque psoriasis who were admitted to Dermatology Clinic or Dermatology Department and 45 healthy controls were enrolled retrospectively in this study.PASI scores of patients with moderate to severe plaque psoriasis that were decreased more than 75% after 16 weeks of MTX systemic treatment were defined as responders(n=49),and the rest were non-responders(n=13).Blood routine parameters and hs-CRP levels were detected before treatment in patients with moderate to severe plaque psoriasis and healthy controls.The correlation between PASI scores and the above indicators was analyzed by Pearson analysis.The differences of blood routine parameters and hs-CRP levels,clinical characteristics of psoriasis between responders and non-responders were compared,and Logistic regression analysis was used to analyze the influencing factors of non-responders.Value of NLR combined with hs-CRP in predicting clinical efficacy of MTX in patients with moderate to severe plaque psoriasis was explored by receiver operating characteristic curve.Results The white blood cells(WBC),neutrophil(N),NLR,hs-CRP and PASI scores in patients with moderate to severe plaque psoriasis before treatment were significantly higher than those after treatment,and the differences were statistically significant.There was no significant difference in the lymphocyte,platelet,platelet distribution width and red blood cell distribution width before treatment,after treatment and between the three groups.Pearson correlation analysis showed that there was a significant positive correlation between WBC,N,NLR,hs-CRP and PASI scores of moderate to severe plaque psoriasis patients before treatment.Logistic regression analysis showed that NLR and hs-CRP were the influencing factors of non-responders.ROC curve showed that NLR combined with hs-CRP had a high value in predicting clinical efficacy in the non-responders,with sensitivity and specificity of 98.42% and 75.31%,respectively.Conclusion NLR combined with hs-CRP is of certain value in predicting the clinical efficacy of MTX in the treatment of moderate to severe plaque psoriasis.Therefore,clinicians can routinely detect the levels of NLR and hs-CRP.