系统性红斑狼疮患者中性粒细胞水平及NLR值与其脏器受累及疾病活动的关系研究

The relationship between neutrophil level and NLR value and organ involvement and disease activity in patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)患者中性粒细胞水平及中性粒细胞/淋巴细胞比值(NLR)与脏器受累、疾病活动的关系。方法纳入郑州市中心医院2020年2月~2023年2月收治的SLE患者106例为SLE组,按照2∶1比例取同期于我院体检的志愿者53例为健康组,比较两组中性粒细胞数、NLR值。根据患者脏器受累情况分为肾损伤组、浆膜炎组、关节炎组,比较各组中性粒细胞计数、NLR值、血肌酐、24h尿蛋白、血尿酸、血尿素氮、白细胞计数(WBC)、C反应蛋白(CRP)、血清总蛋白水平。参考SLE疾病活动指数(SLEDAI)标准将患者分成无活动组、轻中度活动组、重度活动组,比较3组中性粒细胞数、NLR值,分析二者与各实验室指标、SLEDAI评分的相关性。结果SLE组中性粒细胞数、NLR值高于健康组(P<0.05)。肾损伤组中性粒细胞数、NLR值、血肌酐、24h尿蛋白定量、血尿酸、血尿素氮、WBC、CRP水平高于无肾损伤组,血清总蛋白水平低于无肾损伤组(P<0.05)。浆膜炎组与关节炎组中性粒细胞数、NLR值、WBC、CRP水平高于无浆膜炎组、无关节炎组(P<0.05)。重度活动组中性粒细胞数、NLR值高于无活动组、轻中度活动组(P<0.05)。SLE患者中性粒细胞数、NLR值与WBC、CRP、SLEDAI评分呈正相关,与血清总蛋白水平呈负相关(P<0.05)。多因素Logistic回归分析提示,中性粒细胞数、NLR值与SLE患者肾损伤、浆膜炎、关节炎发生以及疾病活动性均相关(P<0.05)。中性粒细胞数评估肾损伤、浆膜炎、关节炎的曲线下面积(AUC)分别为0.776、0.780、0.757,NLR值评估的AUC分别为0.838、0.777、0.778,中性粒细胞数联合NLR值评估的AUC分别为0.875、0.826、0.818(P<0.001)。中性粒细胞数、NLR值单独与联合评估SLE活动期严重度的AUC分别为0.814、0.837、0.885(P<0.001)。结论中性粒细胞水平、NLR值与SLE患者脏器受累、疾病活动有关,二者有望成为预测SLE患者肾损伤、浆膜炎、关节炎发生风险与疾病活动性的指标。

Objective To investigate the relationship between neutrophil level,neutrophil/lymphocyte ratio(NLR)and the involvement of organs and disease activity in patients with systemic lupus erythematosus(SLE).Methods 106 cases of SLE patients were enrolled in Zhengzhou Central Hospital from February 2020 to February 2023.and 53 volunteers who underwent physical examination in our hospital during the same period were selected as healthy group according to 2:1 ratio.Neutrophil counts and NLR values were compared between the two groups.The patients were grouped according to the involvement of the organs,and the neutrophil count,NLR value,serum creatinine,24h urine protein,serum uric acid,blood urea nitrogen,white blood cell count(WBC),C-reactive protein(CRP),and and serum total protein levels were compared in each group.Patients were divided into inactive group,mild to moderate active group and severe active group according to SLEDAI criteria.Neutrophil counts and NLR values in the three groups were compared to analyze the correlation between them and various laboratory indicators and SLEDAI score.Results The neutrophil number and NLR value in SLE group were higher than those in healthy group(P<0.05).The levels of neutrophil number,NLR value,serum creatinine,24h urinary protein quantity,blood uric acid,blood urea,WBC and CRP in renal injury group were higher than those in non-renal injury group,while the level of serum total protein in renal injury group was lower than that in non-renal injury group(P<0.05).The number of neutrophils and NLR in severe activive group were higher than those in inactive group and mild to moderate activive group(P<0.05).The number of neutrophils and NLR value in severe activity group were higher than those in no activity group and mild to moderate activity group(P<0.05).Neutrophil number and NLR were positively correlated with WBC,CRP and SLEDAI score,and negatively correlated with serum total protein level in SLE patients(P<0.05).The area under curve(AUC)for assessment of renal injury,serositis,and arthritis by neutrophil number were 0.776,0.780,and 0.757,respectively,and the AUC for neutrophil count combined with NLR were 0.875,0.826 and 0.818 respectively(P<0.001).The AUCs of neutrophil number and NLR value for assessing the severity of active SLE alone and in combination were 0.814,0.837 and 0.885,respectively(P<0.001).Conclusion Neutrophil levels and NLR values are related to organ involvement and disease activity in SLE patients,and they are expected to be the indicators to predict the risk of renal injury,serositis,arthritis and disease activity in SLE patients.