血小板/淋巴细胞比值与系统性红斑狼疮脏器受累及疾病活动的相关性分析

Correlation Analysis of Platelet to Lymphocyte Ratio with Organ In-volvement and Disease Activity in Systemic Lupus Erythematosus

目的观察血小板淋巴细胞比值(PLR)与系统性红斑狼疮(SLE)脏器受累及疾病活动的相关性。方法选取2014年1月—2018年12月于我院就诊的初治SLE患者120例作为SLE组,同时选取同期于哈尔滨医科大学附属第二医院进行体检的健康者80例作为健康对照组,依据有无肾脏受累或者浆膜炎将SLE患者分为狼疮肾炎(LN)组和无LN组,浆膜炎组和无浆膜炎组,采用SLE疾病活动指数2000(SLEDAI-2000)评估疾病活动度,SLE-DAI<15分为轻中度疾病活动组,SLEDAI>15分为重度疾病活动组。分别比较以上各组的PLR值。同时利用Spearman相关分析PLR与SLE患者实验室指标的相关性,采用Logisitic回归模型分析PLR与SLE疾病活动度之间的关系,通过绘制受试者工作特征曲线(ROC)评价PLR在SLE诊断及活动性评估中的价值。结果SLE组PLR明显高于健康对照组,差异具有统计学意义(P<0.05);SLE组白细胞计数、淋巴细胞计数以及血小板计数明显低于健康对照组,而红细胞分布宽度、尿酸水平明显高于健康对照组,差异具有统计学意义(P<0.05);LN组PLR明显高于无LN组,合并有浆膜炎组PLR明显高于无浆膜炎组,差异具有统计学意义(P<0.05);重度疾病活动(SLEDA≥15分)的SLE患者有78例,中重度疾病活动(SLEDAI<15分)的SLE患者有42例,重度疾病活动组PLR值明显高于轻中度疾病活动组,差异具有统计学意义(P<0.05);Spearman相关分析结果显示,PLR分别与CRP(r=0.567,P=0.015),SLEDAI评分(r=0.875,P=0.001)呈正相关,与血清总蛋白(=-0.502,P=0.002),血清白蛋白(r=-0.611,P<0.001)呈负相关;Logisitic回归分析结果显示PLR是SLE患者疾病活动的独立危险因素(P<0.05);ROC结果显示PLR用于诊断SLE的最佳截断值为174.78,敏感性为70.89%,特异性为87.14%,AUC=0.735,95%CI 0.681~0.813。PLR用于诊断LN的最佳截断值为178.97,敏感性为64.12%,特异性为83.09%,AUC=0.713,95%CI 0.667~0.794。PLR用于诊断SLE患者重度疾病活动的最佳截断值为187.04,敏感性为56.19%,特异性为76.09%,AUC=0.702,95%CI 0.613~0.737。结论PLR与SLE患者的肾脏受累浆膜炎及疾病活动密切相关,提示其作为一种新的炎症指标,对评估SLE疾病活动及脏器受累具有重要意义。

Objective To observe the correlation between platelet to lymphocyte ratio(PL.R)and organ involvement anddisease activity in systemic lupus erythematosus(SLE).Methods 120 SLE patients who were treated in our hospital forthe first time from Jamuary 2014 to December 2018 were selected as SLE group,and 80 healthy patients who were ex-amined in our hospital during the same period were selected as healthy control group.SLE patients were divided into lu-pus nephritis(LN)group,non LNgroup,serositis group and non serositis group according to whether there was renal in-volvement or serositis.SLE disease activity index 2000(SLEDAI-2000)was used to evaluate disease activity.SLEDAI<15 was divided into mild to moderate disease activity group,and SLEDAI>15 was divided into severe disease activitygroup.PLR values of the above groups were compared respectively.Meanwhile,Spearman correlation analysis was usedto analyze the correlation between PLR and laboratory indexes of SLE patients.Logisitic regression model was used toanalyze the relationship between PLR and SLE disease activity,and receiver operating characteristic curve(ROC)wasdrawn to evaluate the value of PLR in SLE diagnosis and activity evaluation.Results PLR in SLE group was signifi-cantly higher than that in healthy control group,and the difference was statistically significant(P<0.05).Leukocyte count,lymphocyte count and platelet count in SLE group were significantly lower than those in healthy control group.while the levels of red blood cell distribution width and uric acid were significantly higher than those in healthy controlgroup,the difference was statistically significant(P<0.05).PLR of LN group was significantly higher than that of nonLN group,and PLR of group with serositis was significantly higher than that of non serositis group,the difference wasstatistically significant(P<0.05).There were 78 SLE patients with severe disease activity(SLEDAI≥15 points)and 42SLE patients with moderate and severe disease activity(SLEDAL<15 points).the PLR value in the severe disease activi-ty group was significantly higher than that in the mild and moderate disease activity group,and the difference was statis-tically significant(P<0.05).Spearman correlation analysis showed that PLR was positively correlated with CRP(r=0.567,P=0.015)and SLEDAI score(r=0.875,P=0.001),and negatively correlated with serum total protein(r=-0.502,P=0.002)and serum albumin(r=-0.611,P<0.001).Logisitic regression analysis showed that PLR was an independentrisk factor for disease activity in SLE patients(P<0.05).ROC curve results showed that the best cutoff value of PLR fordiagnosis of SLE was 174.78,sensitivity was 70.89%,specificity was 87.14%,AUC=0.735,95%C10.681~0.813.Thebest cutoff value of PLR for diagnosis of LN was 178.97,sensitivity was 64.12%,specificity was 83.09%,AUC=0.713,95%C10.667~0.794.The best cutoff value of PLR for diagnosing SLEpatients with severe disease activity was 187.04,sensitivity was 56.19%,specificity was 76.09%,AUC=0.702,95%C10.613~0.737.Conclusion PLR was closely re-lated to renal involvement,serositis and disease activity in SLE patients,suggesting that PLR,as a new inflammatory in-dex,is of great significance in evaluating SLE disease activity and organ involvement.