单核细胞和单核细胞/淋巴细胞比值对判断溃疡性结肠炎严重程度的临床价值

Clinical value of monocytes and monocyte-to-lymphocyte ratio in determining the severity of ulcerative colitis

目的研究单核细胞和单核细胞/淋巴细胞比值(MLR)在溃疡性结肠炎(ulcerative colitis,UC)临床和内镜严重程度评估中的临床价值。方法选取中国科学技术大学附属第一医院2018年1月-2019年9月收治的UC患者102例,选择100例结肠镜检查无异常者作为对照组,回顾性分析不同临床及内镜严重程度的UC患者血单核细胞、MLR的表达。结果 UC患者中MLR、白细胞、单核细胞、血小板水平较对照组明显增高(均P<0.05)。单核细胞与MLR、白细胞、ESR、CRP和血小板均呈正相关(均P<0.05),MLR与白细胞、CRP均呈正相关(均P<0.05)。按改良的Truelove和Witts分型标准和改良Mayo评分分组,单核细胞计数和MLR在中度和重度患者中明显增高(均P<0.05)。按Mayo内镜评分、蒙特利尔分型分组,MLR在Mayo内镜评分3分组中较1分组及2分组明显增高,MLR在E3组较E1组及E2组明显增高(均P<0.05)。ROC曲线分析提示单核细胞计数和MLR的曲线下面积分别为0.740(95%CI:0.672~0.807)和0.750(95%CI:0.683~0.817),差异均有统计学意义(均P<0.001)。单核细胞、MLR最佳临界值分别为0.385×10^9/L、0.235,判断UC的敏感度和特异度分别为81.37%和53.00%、75.49%和66.00%。结论溃疡性结肠炎患者单核细胞、MLR水平明显增高,且与临床和内镜严重程度显著相关。

Objective To assess the clinical value of monocytes and monocytes-to-lymphocytes ratio(MLR) in clinical and endoscopic severity of ulcerative colitis(UC). Methods Total 102 patients with UC and 100 healthy controls were enrolled in the First Affiliated Hospital of University of Science and Technology of China from January 2018 to September 2019. The expression of monocytes and MLR in UC patients with different clinical and endoscopic severity was retrospectively analyzed. Results MLR, white blood cells, neutrophils and platelets in UC patients were significantly higher than those in the healthy controls(all P<0.05). Monocytes was positively correlated with MLR, WBC, ESR, CRP and platelets(all P<0.05), while MLR was positively correlated with WBC and CRP(all P<0.05). According to modified Truelove and Witts’ s severity criteria and modified Mayo score, monocytes and MLR obviously increased in moderate and severe patients(all P<0.05). According to Mayo endoscopy subscore and Montreal classification, MLR increased in the Score 3 group compared with the 1 or 2 groups, and significantly increased in the E3 group compared with the E1 or E2 groups(all P<0.05). The ROC curve analysis showed that the area under the curve of monocytes count and MLR were 0.740(95% CI: 0.672-0.807) and 0.750(95% CI: 0.683-0.817), respectively, with statistical significance(all P<0.001). The optimal critical values of monocytes and MLR were 0.385×10^9/L(sensitivity: 81.37%, specificity: 53.00%) and 0.235(sensitivity: 75.49, specificity: 66.00%), respectively. Conclusion Monocytes and MLR are increased in UC patients and significantly correlated with the clinical and endoscopic severity of UC.