血小板/淋巴细胞比值升高预示中国终末期肾病患者罹患MPO-ANCA相关性血管炎风险降低

Elevated levels of platelet-to-lymphocyte ratio may predict the reduced risk of MPO-ANCA associated vasculitis in Chinese patients with end stage of renal disease

目的:血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)作为一种新型炎症指标,在系统性红斑狼疮和IgA血管炎等炎症疾病中得到了研究。PLR是否可作为评估抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibody,ANCA)相关性血管炎患者疾病活动的生物标志物目前研究较少。本研究旨在探讨中国髓过氧化物酶-抗中性粒细胞胞浆抗体(myeloperoxidase-anti-neutrophil cytoplasmic antibody,MPO-ANCA)相关性血管炎患者诊断时的PLR与炎症反应及疾病活动度的关系,评估PLR是否能预测终末期肾病(end stage of renal disease,ESRD)的进展和全因死亡率。方法:收集MPO-ANCA相关性血管炎患者的临床、实验室、病理特征及预后资料。采用Spearman相关分析检验两个连续变量之间的关联。采用Cox回归分析PLR与ESRD或全因死亡率之间的相关性。结果:连续纳入190名MPO-ANCA相关性血管炎患者。基线PLR与CRP(r=0.333,P<0.001)和ESR(r=0.218,P=0.003)呈正相关。PLR与伯明翰血管炎活动度评分(Birmingham Vasculitis Activity Score,BVAS)无明显相关性。PLR≥330的患者比PLR<330的患者表现出更好的累积肾脏生存率(P=0.017)。然而,PLR≥330的患者和PLR<330的患者在诊断时的累积患者生存率方面差异无统计学意义(P>0.05)。多因素分析结果显示PLR与ESRD风险降低相关(HR=0.518,95%CI:0.278~0.963,P=0.038),没有发现PLR与全因死亡率之间有相关性(HR=1.081,95%CI:0.591~1.976,P=0.801)。结论:PLR与CRP和ESR呈正相关。PLR可以独立预测ESRD的风险。

Objective:Platelet-to-lymphocyte ratio(PLR)has recently been investigated as a new inflammatory marker in many inflammatory diseases,including systemic lupus erythematosus and immunoglobulin A vasculitis.However,there were very few reports regarding the clinical role of PLR in patients with anti-neutrophil cytoplasmic antibody(ANCA)associated vasculitis.This study was thus undertaken to investigate the relationship between inflammatory response and disease activity in Chinese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody(MPO-ANCA)associated vasculitis.Furthermore,we evaluated whether PLR predicts the progression of end stage of renal disease(ESRD)and all-cause mortality.Methods:The clinical,laboratory and pathological data,and the outcomes of MPO-ANCA associated vasculitis patients were collected.The Spearman correlation coefficient was computed to examine the association between 2 continuous variables.Cox regression analysis was used to estimate the association between PLR and ESRD or all-cause mortality.Results:A total of 190 consecutive patients with MPO-ANCA associated vasculitis were included in this study.Baseline PLR was positively correlated with CRP(r=0.333,P<0.001)and ESR(r=0.218,P=0.003).PLR had no obvious correlation with Birmingham Vasculitis Activity Score(BVAS).Patients having PLR≥330 exhibited better cumulative renal survival rates than those having PLR<330(P=0.017).However,there was no significant difference in the cumulative patient survival rates between patients with PLR≥330 and those with PLR<330 at diagnosis(P>0.05).In multivariate analysis,PLR is associated with the decreased risk of ESRD(P=0.038,HR=0.518,95%CI 0.278 to 0.963).We did not find an association between PLR with all-cause mortality using multivariate analysis(HR=1.081,95%CI 0.591 to 1.976,P=0.801).Conclusion:PLR is positively correlated with CRP and ESR.Furthermore,PLR may independently predict the risk of ESRD.