NLR、PLR在托珠单抗治疗类风湿关节炎患者病情活动度及疗效评估中的应用价值

Application value of NLR and PLR in the evaluation of disease activity and efficacy in patients with rheumatoid arthritis treated with tobramzumab

目的探讨托珠单抗(Tochizumab,TCZ)治疗后类风湿关节炎(rheumatoid arthritis,RA)患者外周血的血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)、中性粒细胞/淋巴细胞比率(neutrophil/lymphocyte ratio,NLR)和血小板/淋巴细胞比率(platelet/lymphocyte ratio,PLR)与RA病情活动度的关系及其在监测疗效中的临床价值。方法收集2017年1月至2018年12月在新疆维吾尔自治区人民医院风湿免疫科就诊且使用过TCZ治疗的77例RA患者基线期及治疗24 W后Hb、PLT、血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、NLR、PLR及临床资料(合并用药、关节肿胀数、关节压痛数)。分析上述指标及其差值(ΔHb、ΔPLT、ΔNLR、ΔPLR)与28个关节的疾病活动性评分(disease activity score in 28 joints,DAS28)-ESR及临床疾病活动指数(clinical activity index,CDAI)的相关性。结果PLT、PLR与CDAI和DAS28-ESR均呈正相关(PLT、PLR与CDAI:r值分别为0.44和0.34,P值均<0.05;PLT、PLR与DAS28-ESR:r值分别为0.46和0.34,P值均<0.05);而Hb与CDAI和DAS28-ESR呈负相关(r值分别为-0.32和-0.37,P值均<0.05)。ΔNLR、ΔPLR与ΔCDAI有显著相关性(r值分别为0.32和0.31,P值均<0.05)。ΔPLT与ΔDAS28-ESR呈正相关(r=0.36,P<0.05)。经TCZ治疗后6个月后,PLT、PLR、NLR较基线期显著降低,而Hb较基线期明显升高,组间差异具有统计学意义(t值分别为7.29,6.80,3.86和9.43,P值均<0.05)。PLT升高组、NLR升高组、PLR升高组与PLT正常组、NLR减低组、PLR减低组相比,ΔCDAI明显改善(t值分别为3.15,3.38和8.04,P值均<0.05);Hb减低组和Hb正常组与ΔCDAI无明显相关(P>0.05)。结论ΔPLT、ΔNLR、ΔPLR可以用来监测TCZ的临床疗效。PLT、NLR、PLR基线水平高的RA患者病情改善较多,提示这些血液学标志物可用于指导TCZ治疗。

Objective To investigate the clinical value of hemoglobin(Hb),platelet(PLT),neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR)for estimating disease activity and monitoring efficacy in rheumatoid arthritis(RA)patients treated with tocilizumab(TCZ).Methods Seventy-seven RA patients treated with TCZ in the Department of Rheumatology and Immunology,People's Hospitalof Xinjiang Uygur Autonomous Region were recruited from January 2017 to December 2018.Hb,PLT,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),NLR and PLR were measured at baseline and 24 W after TCZ treatment.The correlations of the above indexes and the difference between the above indicators before and after treatment(ΔHb、ΔPLT、ΔNLR、ΔPLR)with the disease activity score in 28 joints(DAS28)-ESR and clinical activity index(CDAI)were analyzed.Results PLT and PLR were positively correlated with CDAI and DAS28-ESR(PLT,PLR and CDAI:r values were 0.44 and 0.34 respectively,both P values<0.05;PLT,PLR and DAS28-ESR:r values were 0.46 and 0.34 respectively,both P values<0.05).While Hb was negatively correlated with CDAI and DAS28-ESR(r values were-0.32 and-0.37 respectively,both P values<0.05).Significant correlation were found between theΔNLR,PLR(ΔPLR)andΔCDAI(r values were 0.32 and 0.31 respectively,both P values<0.05).TheΔPLT was positively corrlected withΔDAS28-ESR(r=0.36,P<0.05).After 6 months of TCZ treatment,PLT,PLR and NLR were significantly lower than those at baseline,while Hb was significantly higher than those at baseline(t values were 7.29,6.80,3.86 and 9.43 respectively,all P values<0.05).Compared with the PLT normal group,NLR decreased group and PLR decreased group,ΔCDAI was significantly improved in PLT increased group,NLR increased group and PLR increased group(t values were 3.15,3.38 and 8.04 respectively,all P values<0.05).There were no significant correlations betweenΔCDAI and Hb decreased group or Hb normal group(P>0.05).Conclusion TheΔPLT,ΔNLR andΔPLR could be used to evaluate disease activity and monitor clinic response in RA patients treated with TCZ.Patients with high baseline level of PLT,NLR and PLR achieve more improvement,suggesting that these hematologic markers could be used to guide the treatment of TCZ.