PLR在抗核抗体阳性强直性脊柱炎患者中的临床价值

Role of PLR in ankylosing spondylitis patients with positive antinuclear antibody

目的探讨血小板/淋巴细胞比值(PLR)在合并抗核抗体(ANA)阳性强直性脊柱炎(AS)患者中的临床价值。方法选取2018年1月—2021年11月徐州医科大学附属医院AS患者132例(AS组),其中ANA阳性39例、ANA阴性93例。以同期健康体检者98名作为正常对照组。比较2个组一般临床资料的差异。采用Spearman相关分析评价AS组各项指标之间的相关性。采用多因素Logistic回归分析探讨AS患者ANA阳性的危险因素。采用受试者工作特征(ROC)曲线评价相关指标对AS合并ANA阳性的风险预测价值。比较ANA阳性和阴性患者阿达木单抗治疗后相关指标的差异。结果AS组与正常对照组淋巴细胞计数、血小板计数、单核细胞计数、红细胞分布宽度(RDW)、PLR、单核细胞/淋巴细胞比值(MLR)、中性粒细胞/淋巴细胞比值(NLR)、免疫球蛋白(Ig)G、IgA、IgM差异均有统计学意义(P<0.05)。AS患者RDW与红细胞沉降率(ESR)呈正相关(r=0.189,P=0.034),PLR、MLR、NLR与ESR、C反应蛋白(CRP)均呈正相关(P<0.05)。平均血小板体积(MPV)与ESR、CRP呈负相关(r值分别为-0.382、-0.385,P<0.001)。ANA阳性和阴性患者年龄、ESR、CRP、PLR、IgG、淋巴细胞计数、病程差异有统计学意义(P<0.05)。ANA阳性AS患者PLR与ESR、CRP呈正相关(r值分别为0.579、0.691,P<0.001)。PLR、病程是AS患者合并ANA阳性的独立危险因素(P<0.05)。阿达木单抗治疗后,ANA阳性和阴性患者RDW、PLR、ESR、CRP差异均有统计学意义(P<0.05)。结论AS合并ANA阳性患者炎症因子水平较高,治疗效果差。PLR在ANA阳性AS患者中具有一定的临床指导意义。

Objective To investigate the clinical role of platelet-to-lymphocyte ratio(PLR)in patients with ankylosing spondylitis(AS)combined with positive antinuclear antibody(ANA).Methods A total of 132 patients with AS in the Affiliated Hospital of Xuzhou Medical University from January 2018 to November 2021 were enrolled.There were 39 cases of ANA positivity and 93 cases of ANA negativity.Totally,98 healthy subjects during the same period were enrolled as control group.The difference of general clinical data between the 2 groups were compared.Spearman correlation analysis was used to evaluate the correlation between indexes.Multivariate Logistic regression analysis was used to investigate the independent risk factors of ANA positivity in AS patients.Receiver operating characteristic(ROC)curve was used to evaluate the risk predictive value of each index for AS combined with ANA positivity.The index difference of ANA positive and negative patients after treatment with adalimumab was analyzed.Results The differences of lymphocytes,platelets,monocytes,red blood cell distribution width(RDW),PLR,monocyte-to-lymphocyte ratio(MLR),neutrophil-to-lymphocyte ratio(NLR),immunoglobulin(Ig)G,IgA,IgM between AS group and healthy control group were statistically significant(P<0.05).RDW was positively correlated with erythrocyte sedimentation rate(ESR)(r=0.189,P=0.034).PLR,MLR and NLR were positively correlated with ESR and C-reactive protein(CRP)(P<0.05).Mean platelet volume(MPV)was negatively correlated with ESR and CRP(r=-0.382 and-0.385,P<0.001).There was statistical significance in age,ESR,CRP,PLR,IgG,lymphocyte count and disease course between ANA positive and negative groups(P<0.05).For ANA positive patients,PLR was positively correlated with ESR and CRP(r=0.579 and 0.691,P<0.001).PLR and disease course are independent risk factors for AS combined with ANA positivity(P<0.05).The adalimumab treatment effect of patients with positive and negative ANA was followed up,and there was statistical significance in RDW,PLR,ESR and CRP between the 2 groups(P<0.05).Conclusions The ANA positive patients with AS may have high disease activity and poor treatment effect.PLR may play a clinical guiding role in AS patients with ANA positivity.