中性粒细胞/淋巴细胞比值在视神经脊髓炎谱系疾病中的临床价值

Clinical value of neutrophil to lymphocyte ratio in patients with neuromyelitis optica spectrum disorders

目的探究中性粒细胞/淋巴细胞比值(NLR)在视神经脊髓炎谱系疾病(NMOSD)不同亚组和健康人群间的差异,并分析NLR评估神经功能缺损程度的价值。方法选择2016年1月至2021年9月就诊于中国医科大学附属盛京医院的初诊NMOSD患者45例,收集患者的临床资料、生化检查和NLR。根据患者血清水通道蛋白4抗体(AQP4-Ab)检测结果将患者分为AQP4-Ab阳性组和AQP4-Ab阴性组,选择同时期年龄、性别相匹配的健康体检者40人作为健康对照组,并分析各组间临床资料的差异。通过Logistics回归分析评估重度神经功能缺损的危险因素,通过受试者工作曲线(ROC)分析NLR识别重度神经功能缺损的临床价值。结果AQP4-Ab阳性NMOSD组NLR水平高于AQP4-Ab阴性NMOSD组〔3.60(2.08,5.29)比2.00(1.48,2.31),H=2.887,P=0.004〕和健康对照〔3.60(2.08,5.29)比1.83(1.35,2.17),H=4.512,P=0.000〕,且NLR是NMOSD患者重度神经功能缺损的独立危险因素〔OR(95%CI)=13.506(1.050~173.753),P=0.046〕。NLR识别重度神经功能缺损的ROC下面积(AUC)为0.856(95%CI:0.746~0.996,P=0.000),最佳截断值为3.33,其灵敏度和特异度分别为0.720、1.000(P=0.000)。结论AQP4-Ab阳性患者NLR升高较AQP4-Ab阴性患者更为明显。NLR可用于识别重度神经功能缺损。

Objective To explore the difference in neutrophil to lymphocyte ratio(NLR)between patients with neuromyelitis optica spectrum disorders(NMOSD)and healthy people and evaluate the clinical value of NLR in predicting neurological impairment in NMOSD.Methods We retrospectively analyzed 45 patients admitted to Shengjing hospital of China Medical University from 2016 to 2021 and selected their clinical data,laboratory test and NLR.According to the test results of serum aquaporin 4 antibody(AQP4-Ab),the patients were divided into AQP4-Ab positive[AQP4-Ab(+)]group and AQP4-Ab negative[AQP4-Ab(+)]group.A total of 40 healthy people who were matched for age and gender during the same period were selected as the healthy controls.And we analyzed the differences in clinical data among three groups.Logistic regression analysis was used to evaluate the risk factors of severe neurological deficit,and receiver-operating characteristic curve(ROC)was used to analyze the clinical value of NLR in predicting severe neurological deficit.Results NLR was significantly higher in patients with AQP4-Ab(+)NMOSD than in those with AQP4-Ab(-)NMOSD[3.60(2.08,5.29)vs.2.00(1.48,2.31),H=2.887,P=0.004]and in the healthy controls[3.60(2.08,5.29)vs.1.83(1.35,2.17),H=4.512,P=0.000].In addition,NLR is an independent risk factor for severe neurological deficit.The area under ROC curve(AUC)of NLR identifying severe neurological deficit was 0.856(95%CI 0.746-0.996,P=0.000).The cut-off value was 3.33,and the sensitivity and specificity were 0.720 and 1.000 respectively(P=0.000).Conclusions The patients with AQP4-Ab(+)NMOSD had higher NLR than AQP4-Ab(-)NMOSD.The NLR can be used as a biomarker to identify severe neurological deficit of NMOSD.