血液学指标在评估视神经脊髓炎谱系病患者疾病严重程度和治疗效果中的价值

The Value of Hematological Indexes in Evaluating Disease Severity and Therapeutic Effect in Patients with Neuromyelitis Optica Spectrum Disease

目的观察常见血液学指标在评估视神经脊髓炎谱系病(NMOSD)疾病严重程度和激素治疗效果中的价值。方法纳入2015年8月至2020年4月安徽医科大学第一附属医院收治的101例初诊NMOSD患者,治疗前收集患者的一般资料及血液学指标[包括白细胞(WBC)、红细胞(RBC)、血红蛋白(HB)、血小板(PLT)、红细胞分布宽度(RDW)和全血细胞计数衍生参数如中性粒细胞淋巴细胞比率(NLR)、血小板淋巴细胞比率(PLR)、单核细胞淋巴细胞比率(MLR)、嗜酸性粒细胞淋巴细胞比率(ELR)、单核细胞高密度脂蛋白比率(MHR),以及C反应蛋白(CRP)、铁蛋白(FER)、肌酐(CR)、尿酸(UA)、总胆红素(TB)等指标],分别在患者治疗前后行扩展残疾状态量表(EDSS)评分,依据EDSS评分将NMOSD患者病情严重程度分为轻、中、重3组,比较3组间一般资料及血液学指标的差异。结果3组患者年龄、性别、RBC、HB、RDW、PLT、PLR、ELR、MHR、TB、CR、UA等指标差异无统计学意义(P>0.05);3组间WBC、NLR、MLR、CRP、FER水平比较,差异有统计学意义(P<0.05)。有序logistic回归分析结果表明,NLR(OR:1.566,95%CI:1.202~2.039,P<0.05)、FER(OR:1.003,95%CI:1.000~1.005,P<0.05)是NMOSD患者疾病严重程度的独立危险因素。Spearman相关分析结果显示,治疗前EDSS评分与WBC、NLR、MLR、CRP、FER成正相关(r=0.238、0.454、0.339、0.301、0.362,P<0.05);病情变化ΔEDSS(ΔEDSS=治疗前EDSS-治疗后EDSS)与CR成正相关(r=0.420,P<0.05),与MLR呈负相关(r=-0.199,P<0.05)。结论NMOSD患者血液学指标NLR、FER有助于判断疾病严重程度,CR、MLR与激素治疗效果相关。

Objective To observe the value of common hematological indexes in evaluating the disease severity and therapeutic effect of patients with neuromyelitis optic spectrum disease.Methods A total of 101 newly diagnosed NMOSD patients admitted to the First Affiliated Hospital of Anhui Medical University from August 2015 to April 2020 were included.The general information and hematological indexes[including white blood cell(WBC),red blood cell(RBC),hemoglobin(HB),platelet(PLT),erythrocyte distribution width(RDW),and whole blood cell count derivative parameters,such as neutrophil-lymphocyte ratio(NLR),platelet lymphocyte ratio(PLR),monocyte lymphocyte ratio(MLR),eosinophil lymphocyte ratio(ELR),monocyte high-density lipoprotein ratio(MHR),C-reactive protein(CRP),ferritin(FER),creatinine(CR),uric acid(UA),total bilirubin(TB)]of NMOSD patients were collected before glucocorticoid treatment.The patients were scored with the extended disability scale(EDSS).The scale was evaluated before and after treatment.NMOSD patients were divided into three groups according to EDSS:mild、moderate、and severe.Multivariate logistic regression was used to analyze the relationship between hematological indexes and disease severity.Spearman correlation analysis was used to analyze the relationship between hematological indexes and EDSS score before glucocorticoid treatment Spearman correlation analysis was also performed between hematological indexes andΔEDSS(ΔEDSS=Pre-treatment EDSS minus post-treatment EDSS).Results By comparing the general data and hematological indexes among the three groups,there were no statistical differences in age,sex,RBC,HB,RDW,PLT,PLR,ELR,MHR,TB,CR,and UA among the three groups of NMOSD patients(P>0.05).The indexes of differences among the three groups were WBC、NLR、MLR、CRP、FER(P<0.05).Multivariate logistic regression analysis showed that NLR(OR:1.566,95%CI:1.202~2.039,P<0.05)、FER(OR:1.003,95%CI:1.000~1.005,P<0.05)were independent risk factors for the severity of NMOSD patients.Spearman correlation analysis showed that EDSS scores before treatment were positively correlated with WBC、NLR、MLR、CRP,and FER(r=0.238、0.454、0.339、0.301、0.362,P<0.05).ΔEDSS was positively correlated with CR(r=0.420,P<0.001)and negatively correlated wit h MLR(r=-0.199,P<0.05).Conclusion Hematological indexes NLR and FER in patients with NMOSD are helpful to judge the severity of the disease;CR and MLR are related to the effect of glucocorticoid therapy.