NLR、PLR及SII对白芍总苷联合孟鲁司特治疗小儿过敏性紫癜的临床疗效预测研究

Clinical prediction of NLR,PLR and SII on total glucoside of paeoniae alba combined with montelukast intreatment of children with allergic purpura

目的研究中性粒细胞和淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)、血小板和淋巴细胞比值(Platelet to lymphocyte ratio,PLR)和系统性免疫炎症指数(Systemic immune-inflammation index,SII)预测白芍总苷联合孟鲁司特治疗小儿过敏性紫癜(Henoch-Schonlein purpura,HSP)的临床疗效。方法以2021年1月-2021年12月于徐州医科大学附属医院皮肤科收治的110例过敏性紫癜患儿为研究对象。记录所有患儿的性别、年龄、BMI、家族史。治疗前,采用BC-6800 Plus全自动血液分析仪(深圳迈瑞公司)检测血小板、淋巴细胞、单核细胞和中性粒细胞计数,计算NLR、PLR和SII。所有患儿均采用白芍总苷联合孟鲁司特治疗,治疗4周后评估治疗效果。结果共89例(80.91%)患儿有效,21例(19.09%)患儿无效。与无效组比较,有效组患儿的性别、年龄、BMI、家族史差异无统计学意义(P>0.05),病情严重程度较轻,差异有统计学意义(P<0.05)。与无效组比较,有效组患儿的NLR、PLR、SII水平和治疗前的症状总积分值降低,差异有统计学意义(P<0.05)。所有患儿的NLR、PLR及SII水平与症状总积分值呈显著正相关关系。多因素Logistic回归分析结果显示,病情严重程度、NLR、PLR和SII是治疗后无效的独立危险因素(P<0.05)。应用NLR预测白芍总苷联合孟鲁司特治疗HSP疗效受试者工作特征(Receiver operating characteristic,ROC)曲线分析结果显示,NLR预测的曲线下面积(Area under the curve,AUC)为0.731(0.582~0.880),灵敏度和特异度分别为71.4%和70.8%;PLR预测的AUC为0.764(0.649~0.878),灵敏度和特异度分别为76.2%和75.3%;SII预测的AUC为0.822(0.735~0.909),灵敏度和特异度分别为81.0%和77.4%。结论NLR、PLR及SII与白芍总苷联合孟鲁司特治疗HSP疗效有关,具有一定预测价值。

Objective The aim of this study was to investigate neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and systemic immune-inflammation index(SII)predicted the clinical efficacy of total glucoside of paeoniae alba combined with montelukast in the treatment of children with allergic purpura(HSP).Methods Children with henoch schonlein Purpura treated in the hospital from January 2021 to December 2021 were selected as the research subjects.Gender,age,BMI and family history of the children were recorded.Before thetreatment,platelet count,lymphocyte count,monocyte count and neutrophil count were measured by BC-6800 Plus automatic hematology analyzer(Mindray Shenzhen),and NLR,PLR and SII were calculated.The children were treated with total glucosides of paeoniae paeoniae combined with montelukast,and the therapeutic effect was evaluated after 4weeks of the treatment.Results A total of 89 cases(80.91%)were effective,and 21 cases(19.09%)were ineffective.Compared with the ineffective group,there was no significant difference in gender,age,BMI and family history in the effective group(P>0.05),but the severity of the disease wasincreased,with statistical significance(P<0.05).Compared with the ineffective group,the levels of NLR,PLR,SII and the total score of symptoms before the treatment in the effective group were decreased,with statistical significance(P<0.05),and there was a significant positive correlation between the levels of NLR,PLR and SII and the total symptom score inthe children.Multivariate Logistic regression analysis showed that disease severity,NLR,PLR and SII were independent risk factors for failure after the treatment(P<0.05).The AUC predicted by NLR on the treatment of HSP was 0.731(0.582~0.880),the sensitivity and specificity were 71.4%and 70.8%,respectively.The Predictive AUC of PLR was 0.764(0.649~0.878),and the sensitivity and specificity were 76.2%and 75.3%,respectively.The Predictive AUC of SII was 0.822(0.735~0.909),and the sensitivity and specificity were 81.0%and 77.4%,respectively.Conclusion NLR,PLR and SII are related to the curative effect of total glucosides of paeonia lactiflora combined with Montelukast in the treatment of HSP,which has thecertain predictive value.