中性粒细胞与淋巴细胞比值对重症红斑狼疮的预测价值研究

The predictive value of neutrophil-to-lymphocyte ratio in severe lupus erythematosus

目的探讨重症红斑狼疮(SSLE)发病的相关影响因素,探索中性粒细胞与淋巴细胞比值(NLR)与重症红斑狼疮发病之间的关系,为SSLE早期干预提供数据支持。方法回顾性收集2013年1月至2020年12月该院风湿免疫科住院的400例系统性红斑狼疮(SLE)患者的病例数据,分为SLE组(358例)和SSLE组(42例),采用倾向性评分匹配法匹配两组基线资料,共成功匹配41例患者(SSLE:SLE=1:3)。比较匹配后两组一般情况、实验室指标的差异,采用logistic回归模型探索SSLE发病的相关影响因素,采用受试者工作特征(ROC)曲线分析NLR的诊断价值。结果倾向性评分匹配后,与SLE组比较,SSLE组红细胞沉降率(ESR)、超敏C反应蛋白(CRP)、中性粒细胞百分比(N%)、中性粒细胞与淋巴细胞比值(NLR)、24 h尿蛋白量、肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、甘油三酯(TG)、D-二聚体水平、心血管疾病率、合并狼疮性脑病和感染率更高,淋巴细胞百分比(LYM%)、红细胞(RBC)、血红蛋白(Hb)、血小板(PLT)、血清总蛋白(TP)、清蛋白(ALB)、高密度脂蛋白(HDL)、补体水平、中医药治疗比例更低(P<0.05)。logistic回归结果显示,NLR升高、合并感染、心血管疾病史是SSLE发病的相关危险因素(P<0.05)。ROC曲线显示NLR诊断SSLE的AUC为0.713(95%CI:0.625~0.780),其预测价值不受合并感染、心血管既往史的影响。结论NLR作为SSLE的早期预警标志物,具有一定临床价值。

Objective To investigate factors associated with severe lupus erythematosus(SSLE),explore the relationship between neutrophil-to-lymphocyte ratio(NLR)and the development of severe lupus erythematosus,and provide clinical evidence to support early intervention in SSLE.Methods Case data of 400 patients with systemic lupus erythematosus(SLE)from January 2013 to December 2020 were retrospectively collected and divided into SLE group(358 patients)and SSLE group(42 patients),and baseline data of the two groups were matched using propensity score matching method,and a total of 41 patients were successfully matched(SSLE.SLE=1:3).The differences in general conditions and laboratory indicators between the two groups after matching were compared.Logistic regression models were used to explore the factors associated with the onset of SSLE,and the diagnostic value of NLR was analyzed using the subject operating characteristic(ROC)curve.Results Compared with the SLE group,the SSLE group had longer hospitalization days,higher levels of inflammatory indicators,severe haematological involvement,more proteinuria,poor renal function,higher triglyceride levels,lower complement levels,higher D-dimer,and more combined cardiovascular disease,lupus encephalopathy and lupus nephropathy,with statistically significant differences(P<0.05).The ROC curve showed an AUC of 0.713(95%CI:0.625-0.780)for the diagnosis of SSLE,and its predictive value was not affected by co-infection and cardiovascular history.According to the model,higher NLR,co-infection and history of cardiovascular disease are risk factors for the development of SSLE(P<0.05).Conclusion NLR has clinical value as an early warning marker for SSLE.