中性粒细胞/淋巴细胞联合血小板/淋巴细胞对儿童克罗恩病活动期的诊断价值

The diagnostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in the active period of pediatric Crohn′s disease

目的探讨中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞(PLR)与儿童克罗恩病(CD)活动度的相关性,同时分析NLR、PLR独立及联合预测儿童CD活动期的效能。方法回顾分析2017年6月至2020年3月南京医科大学附属儿童医院消化科收治的CD患儿43例(145例次),按照儿童CD活动指数(PCDAI)评分将患儿住院例次分为缓解期组(94例次)、轻度活动期组(29例次)、中重度活动期组(22例次)。收集患儿的一般资料及各组患儿入院次日的NLR、PLR结果。结果轻度活动期组和中重度活动期组的NLR、PLR水平均高于缓解期组[NLR:2.96(2.25,4.12)比1.10(0.77,1.92),3.25(2.50,5.53)比1.10(0.77,1.92);PLR:194.97(143.30,238.64)比101.83(81.75,147.40),198.85(166.95,244.95)比101.83(81.75,147.40),P均<0.001],但轻度活动期组和中重度活动期组差异无统计学意义。NLR、PLR与CD活动度存在较强的正相关(分别为rs=0.622,P<0.001;rs=0.582,P<0.001)。NLR、PLR预测CD活动期的截断值为1.64、136.88;曲线下面积(AUC)分别为0.877、0.855;敏感性、特异性分别为:96.08%、71.28%和84.31%、74.47%。NLR与PLR联合预测的AUC为0.891,敏感度为86.27%、特异度为78.72%。结论NLR、PLR均可用来区分儿童CD的活动期与缓解期,两者联合用于诊断儿童CD活动期时有较大的AUC及较高的灵敏度及特异度。

Objective To evaluate the correlation of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)with the activity of pediatric Crohn′s disease(CD),and to study the efficacy of NLR and PLR independently and combinedly in predicting active period of pediatric CD.Methods A total of 43 children with CD(145 clinical records)admitted to Gastroenterology Department of Children′s Hospital of Nanjing Medical University from June 2017 to March 2020 were analyzed retrospectively.According to pediatric Crohn′s disease activity index,the clinical records were divided into inactive group(94 cases),mild active group(29 cases),moderate to severe active group(22 cases).General information of the children and NLR and PLR results of each group on the second day after admission were collected.Results The levels of NLR and PLR in mild active group and moderate to severe group were higher than those in inactive group[NLR:2.96(2.25,4.12)vs.1.10(0.77,1.92),3.25(2.50,5.53)vs.1.10(0.77,1.92);PLR:194.97(143.30,238.64)vs.101.83(81.75,147.40),198.85(166.95,244.95)vs.101.83(81.75,147.40),P<0.001],but there was no significant difference between mild active group and moderate to severe active group.There were a strong positive correlation between NLR and PLR with CD activity(rs=0.622,P<0.001;rs=0.582,P<0.001,respectively).The cut-off values of NLR and PLR for predicting CD activity were 1.64 and 136.88,and the AUC was 0.877 and 0.855,respectively.The corresponding sensitivity and specificity were 96.08%,71.28%and 84.31%,74.47%,respectively.When NLR was combined with PLR,AUC was 0.891,sensitivity was 86.27%,and specificity was 78.72%.Conclusions NLR and PLR can be used to distinguish the active and inactive periods of pediatric CD.The combination of NLR and PLR can be used to diagnose the active period of pediatric CD with higher AUC,sensitivity and specificity.