血液学参数比值在中轴型脊柱关节炎病情评估中的价值

Value of hematologic parameter ratios in evaluating the disease activity of axial spondyloarthritis

目的探讨血液学参数比值在中轴型脊柱关节炎(ax-SpA)病情评估中的价值。方法回顾性分析并比较170例ax-SpA患者(ax-SpA组)和170例健康体检者(对照组)的血液学参数及其比值。再依据强直性脊柱炎疾病活动度评分(ASDAS)将ax-SpA患者分为ASDAS<2.1组116例和ASDAS≥2.1组54例,比较两组患者的血液学参数及其比值。采用二元logistic回归分析探讨ax-SpA患者疾病活动的危险因素。采用Pearson相关分析评估ax-SpA患者血液学参数比值与其他指标的相关性。采用受试者工作特征(ROC)曲线衡量各指标评估ax-SpA疾病活动度的价值。比较148例ax-SpA患者治疗前后的血液学参数及其比值。结果ax-SpA组患者WBC、中性粒细胞(NEU)、单核细胞(MO)、PLT、球蛋白(Glb)、NEU/淋巴细胞(LY)比值(NLR)、PLT/LY比值(PLR)、MO/LY比值(MLR)、PLT/PLT分布宽度比值(PPR)均高于对照组,LY和白蛋白(Alb)均低于对照组(P<0.05)。ASDAS≥2.1组患者WBC、NEU、MO、Glb、NLR、PLR、MLR及C反应蛋白(CRP)/Alb比值(CAR)均高于ASDAS<2.1组,Alb低于ASDAS<2.1组(P<0.05)。二元logistic回归分析结果显示,红细胞沉降率(ESR)、CRP及CAR是ax-SpA患者疾病活动的独立危险因素(P<0.05)。Pearson相关分析结果显示,ax-SpA患者NLR、MLR、CAR与ESR、CRP、Bath强直性脊柱炎疾病活动性指数(BASDAI)、ASDAS-ESR、ASDAS-CRP均呈正相关,PLR、PPR与ESR、CRP、ASDAS-ESR、ASDAS-CRP均呈正相关(P<0.001)。ROC曲线分析结果显示,CAR、MLR、PLR、NLR对ax-SpA患者疾病活动度的评估均有一定价值(P<0.05)。治疗后ax-SpA患者的CAR、NLR、Alb、WBC、NEU均低于治疗前(P<0.05)。结论NLR、PLR、MLR和CAR可作为评估ax-SpA患者疾病活动的有效炎症标志物,ESR、CRP及CAR是其疾病活动的独立危险因素,CAR、NLR、Alb、WBC计数及NEU可用于评估ax-SpA患者疗效。

Objective To explore value of hematologic parameter ratios in evaluating disease activity of axial spondyloarthritis(ax-SpA).Methods Hematologic parameter and their ratios in 170 ax-SpA patients(ax-SpA group)and 170 healthy controls(control group)were retrospectively analyzed and compared.According to the ankylosing spondylitis disease activity score(ASDAS),ax-SpA patients were divided into ASDAS<2.1 group(116 cases)and ASDAS≥2.1 group(54 cases),hematologic parameter and their ratios between above two groups were compared.Risk factors of disease activity were analyzed by binary logistic regression.Correlations between hematologic parameter and their ratios and diseases activity were analyzed by Pearson correlation analysis.Receiver operating characteristic(ROC)curve was drawn to investigate the value of hematologic parameter ratios in evaluating the disease activity of ax-SpA.In addition,hematologic parameter ratios before and after treatment in 148 cases ax-SpA patients were compared.Results WBC,neutrophil(NEU),monocytes(MO),PLT,globulin(Glb),NEU to lymphocyte(LY)ratio(NLR),PLT to LY ratio(PLR),MO to LY ratio(MLR)and PLT to PLT distribution width ratio(PPR)in ax-SpA group were higher than those in control group,LY and albumin(Alb)in ax-SpA group were lower than those in control group(P<0.05).WBC,NEU,MO,Glb,NLR,PLR,MLR and CRP to Alb ratio(CAR)in ASDAS≥2.1 group were higher than those in ASDAS<2.1 group,Alb was lower than that in ASDAS<2.1 group(P<0.05).Binary logistic regression showed that ESR,CRP and CAR were independent risk factors of disease activity of ax-SpA patients.Pearson correlation analysis showed that NLR,MLR and CAR were positively correlated with ESR,CRP,BASDAI,ASDAS-ESR,ASDAS-CRP,PLR and PPR were positively correlated with ESR,CRP,ASDAS-ESR,ASDAS-CRP in ax-SpA patients.ROC curve showed that CAR,MLR,PLR and NLR were of certain value in evaluating disease activity of ax-SpA patients.CAR,NLR,WBC,NEU and Alb after treatment were lower than those before treatment in ax-SpA patients(P<0.05).Conclusion NLR,PLR,MLR and CAR may serve as effective inflammatory markers to evaluate disease activity of ax-SpA patients.ESR,CRP and CAR are independent risk factor of their disease activity,CAR,NLR,Alb,WBC and NEU can be used to evaluate efficacy of ax-SpA patients.