炎症性肠病患者外周血低密度粒细胞的表达及临床意义

Expression and clinical significance of low-density granulocytes in peripheral blood of patients with inflammatory bowel disease

目的探讨炎症性肠病(IBD)患者外周血低密度粒细胞(LDGs)表达水平及临床意义。方法采用横断面调查研究方法。收集2022年8月至2023年1月就诊于安徽医科大学第一附属医院消化内科的IBD患者的临床资料。选择45例健康体检者作为正常对照组。克罗恩病(CD)疾病活动评估采用克罗恩病简化内镜评分(SES-CD),溃疡性结肠炎(UC)疾病活动评估采用Mayo内镜评分(MES)。实验室指标包含LDGs、白细胞计数(WBC)、血红蛋白(HB)、血小板计数(PLT)、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)和粪便钙卫蛋白(FC)。分析IBD患者与正常对照组LDGs水平差异,以及IBD患者LDGs水平与临床特征的关系。通过受试者工作特征曲线计算LDGs对IBD疾病活动的预测价值。结果共纳入130例IBD患者,其中CD 83例,UC 47例。与正常对照组相比,CD组、UC组LDGs水平均明显更高[CD:0.53%(0.32%,1.41%)比0.19%(0.12%,0.29%),H=57.71,P<0.001;UC:0.87%(0.43%,1.90%)比0.19%(0.12%,0.29%),H=73.23,P<0.001]。与缓解期相比,活动期CD患者LDGs水平更高(P<0.001);与轻度活动期相比,中度及重度活动期CD患者LDGs水平均更高(均P<0.05)。不同疾病行为方面,狭窄型CD患者LDGs水平最高[1.37%(0.91%,3.06%),均P<0.05]。与缓解期相比,活动期UC患者LDGs水平更高(P<0.001)。与轻度活动期相比,中度及重度活动期UC患者LDGs水平均更高(均P<0.05)。CD组LDGs水平与CRP、FC、NLR、PLT、简易克罗恩病活动指数(CDAI)评分及SES-CD均呈正相关(r分别为0.374、0.548、0.345、0.284、0.764、0.721,均P<0.05)。UC组患者LDGs水平与CPR、FC、NLR、Sutherland疾病活动指数(DAI)及MES均呈正相关(r分别为0.325、0.666、0.474、0.638、0.740,均P<0.05)。CD患者中,LDGs截断值取0.565%时,曲线下面积(AUC)为0.873,敏感性73.50%,特异性99.30%。UC患者中,LDGs截断值取0.545%时,AUC为0.877,敏感性76.90%,特异性100.00%。结论IBD患者中LDGs呈高表达,与疾病活动相关,可能作为IBD患者临床评估的生物学标志物。

Objective To explore the expression level and clinical significance of low-density granulocytes(LDGs)in peripheral blood of patients with inflammatory bowel disease(IBD).Methods A cross-sectional survey was conducted.Clinical data of IBD patients admitted to the Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University from August 2022 to January 2023 were collected.A total of 45 healthy people were enrolled as the normal control group.Simple endoscopic score for Crohn′s disease(SES-CD)was used to evaluate the activity of Crohn′s disease(CD)and Mayo endoscopic score(MES)was used to evaluate the activity of ulcerative colitis(UC).Laboratory indicators included LDGs,white blood cell count(WBC),hemoglobin(HB),platelet count(PLT),C-reactive protein(CRP),neutrophil to lymphocyte ratio(NLR),and fecal calprotectin(FC).The difference in LDGs level between IBD patients and the normal control group was statistically analyzed and the relationship between LDGs level and clinical characteristics of IBD patients was analyzed.Receiver operating characteristic(ROC)curve was used to calculate the predictive value of LDGs for the disease activity of IBD.Results A total of 130 IBD patients were included,including 83 CD patients and 47 UC.Compared with the normal control group,the LDGs levels of patients in the CD group and UC group were respectively higher[CD:0.53%(0.32%,1.41%)vs.0.19%(0.12%,0.29%),H=57.71,P<0.001;UC:0.87%(0.43%,1.90%)vs.0.19%(0.12%,0.29%),H=73.23,P<0.001].Compared with the CD patients in remission phase,the level of LDGs in active CD patients was higher(P<0.001).Compared with the CD patients in mild activity phase,the LDGs levels of CD patients in moderate and severe activity phases were higher(all P<0.05).In terms of different disease behaviours,the level of LDGs in stricturing CD patients was the highest[1.37%(0.91%,3.06%),all P<0.05].Compared with the UC patients in remission phase,the level of LDGs in active UC patients was higher(P<0.001).Compared with the UC patients in mild activity phase,the LDGs levels of UC patients in moderate and severe activity phases were higher(all P<0.05).In the CD group,LDGs level was positively correlated with CRP,FC,NLR,PLT,simple Crohn′s disease activity index(CDAI),and SES-CD(r=0.374,0.548,0.345,0.284,0.764,0.721,all P<0.05).In the UC group,LDG levels was positively correlated with CRP,FC,NLR,Sutherland disease activity index(DAI),and MES(r=0.325,0.666,0.474,0.638,0.740,all P<0.05).In CD patients,the cut-off value of LDGs was 0.565%,with the area under curve(AUC)of 0.873,sensitivity of 73.50%,and specificity of 99.30%.In UC patients,the cut-off value of LDGs was 0.545%,with the AUC of 0.877,sensitivity of 76.90%,and specificity of 100.00%.Conclusion The expression of LDGs in IBD patients is significantly high,which correlates with the disease activity and may be used as a biological marker for the clinical evaluation of IBD patients.