全血细胞计数指标监测大动脉炎疾病活动性中的作用

Role of whole blood cell count indicators in monitoring the activity of Takayasu arteritis

目的探讨中性粒细胞/淋巴细胞(NLR)、红细胞分布宽度(RDW)、血小板/淋巴细胞(PLR)、血小板平均体积(MPV)、血小板压积(PCT)和血小板分布宽度(PDW)与大动脉炎(TA)疾病活动性的关系。方法回顾性分析2017年1月至2019年6月安贞医院86例TA患者(TA组),同时从北京安贞医院健康体检中心选取年龄和性别与TA相匹配的健康对照者85名(对照组)。所有对象静脉采血,用电阻抗法检测中性粒细胞/淋巴细胞(NLR)、红细胞分布宽度(RDW)、血小板/淋巴细胞(PLR)、血小板平均体积(MPV)、血小板压积(PCT)和血小板分布宽度(PDW)。根据美国国立研究院(NIH)评分及印度TA临床活动性评分(ITAS2010)判断TA活动性。对TA组和对照组间的临床资料进行比较,采用Spearman相关分析评价全血细胞计数指标与ESR和高敏C反应蛋白(hs-CRP)的关系,采用受试者工作特征(ROC)曲线确定判断TA疾病活动性的界值。结果TA患者组的NLR、RDW和PDW均高于对照组[分别为3.00(1.78~3.48)比1.76(1.34~2.01)、14.10(13.00~14.83)比13.08(12.50~13.35)和13.65(11.20~16.00)比12.24(11.20~13.20),P均<0.0001],TA患者组的MPV和PCT均低于对照组[分别为10.06±1.11比10.44±0.83和0.25(0.20~0.28)比0.27(0.23~0.31),P值分别为0.011和0.014]。TA患者活动期的RDW和PCT均高于非活动期[分别为14.61(13.38~15.48)比13.81(12.88~14.33)和0.27±0.07比0.23±0.06,P值分别为0.007和0.008]。TA患者活动期的PCT与ESR呈正相关(r=0.33,P=0.002)。RDW判断TA疾病活动性的最佳界值为14.150(敏感度为55.0%,特异度为100.0%,ROC曲线下面积为0.802);PCT判断TA疾病活动性的最佳界值为0.245(敏感度为66.7%,特异度为92.3%,ROC曲线下面积为0.84);PLR判断TA疾病活动性的最佳界值为131.257(敏感度为71.7%,特异度为76.9%,ROC曲线下面积为0.714)。结论RDW和PCT可能有助于判断TA疾病活动性,而全血细胞计数中的其他指标与TA疾病活动性关系不密切。

Objective To investigate the relationship between neutrophil/lymphocyte(NLR),red blood cell distribution width(RDW),platelet/lymphocyte(PLR),platelet mean volume(MPV),platelet hematocrit(PCT)and platelet distribution width(PDW)and the disease activity of Takayasu arteritis(TA).Methods A retrospective analysis was conducted on 86 TA patients(TA group)in Anzhen hospital from January 2017 to June 2019.Meanwhile,85 healthy controls(control group)whose age and gender matched with TA were selected from the health examination center of Beijing Anzhen hospital.The blood samples were collected to measure the neutrophil/lymphocyte(NLR),red blood cell distribution width(RDW),platelet/lymphocyte(PLR),platelet mean volume(MPV),platelet hematocrit(PCT)and platelet distribution width(PDW)by resistance method.TA activity was determined according to the national institutes of health(NIH)score and India TA clinical activity score(ITAS2010).Spearman correlation analysis was used to evaluate the relationship between whole blood cell count indicators and ESR and hs-CRP.ROC curve was used to determine the threshold of TA disease activity.Results The NLR,RDW and PDW in the TA group were higher than those in the control group[3.00(1.78-3.48)vs.1.76(1.34-2.01),14.10(13.00-14.83)vs.13.08(12.50-13.35)and 13.65(11.20-16.00)vs.12.24(11.20-13.20),P<0.0001].MPV and PCT in the TA group were lower than those in the control group[10.06±1.11 vs.10.44±0.83 and 0.25(0.20-0.28)vs.0.27(0.23-0.31),P=0.011 and 0.014,respectively].RDW and PCT in the active group of TA patients were both higher than those in the inactive group[14.61(13.38-15.48)vs.13.81(12.88-14.33)and 0.27±0.07 vs.0.23±0.06],with P values of 0.007 and 0.008,respectively.PCT in the active group of TA patients was positively correlated with ESR(r=0.33,P=0.002).The optimal RDW threshold for determining the activity of TA disease was 14.150(sensitivity was 55.0%,specificity was 100.0%,area under ROC curve was 0.802).The optimal threshold for judging the activity of TA disease by PCT was 0.245(sensitivity was 66.7%,specificity was 92.3%,area under ROC curve was 0.84).The optimal threshold for PLR to determine the activity of TA disease was 131.257(sensitivity was 71.7%,specificity was 76.9%,area under ROC curve was 0.714).Conclusion RDW and PCT may be helpful to judge the activity of TA,however,the other indexes of whole blood cell count were not closely related to the activity of TA.