中性粒细胞与淋巴细胞比值在女性外阴硬化性苔藓患者继发甲状腺异常风险预测中的价值

Predictive value of NLR in secondary thyroid abnormalities in female patients with vulvar lichen sclerosus

目的:探讨中性粒细胞与淋巴细胞比值(NLR)在女性外阴硬化性苔藓(VLS)患者继发甲状腺异常中的预测价值。方法:从2014年1月-2018年6月确诊的女性VLS患者中随机抽取273例,进行外周血NLR水平追踪,研究追踪时间截止至2018年12月31日,甲状腺异常者在第一次出现异常时即停止追踪。VLS继发甲状腺异常者设为观察组,其余为对照组,比较两组患者的甲状腺激素及抗体水平的差异,并采用Pearson相关分析NLR与外阴白斑面积、甲状腺激素及抗体水平的相关性,同时采用ROC曲线评估NLR在预测女性VLS患者继发甲状腺异常中的临床效能。结果:VLS患者平均年龄为(42.17±8.65)岁,皮损部位多局限于大小阴唇及阴道口,多数呈现色素脱失或减退。甲状腺异常发生率为13.92%(38/273),出现甲状腺异常的平均时间为(15.21±3.48)个月,以TPO-Ab和TSH水平异常为主。Pearson相关分析显示NLR与外阴白斑面积、TSH及TPO-Ab水平均呈正相关性(r值分别为0.232、0.531、0.499)。ROC曲线结果显示,NLR预测女性VLS患者继发甲状腺异常的ROC曲线下面积为0.906(95%CI:0.841～0.971),当NLR为5.585时,约登指数为0.736,敏感度为84.2%,特异度为89.4%。结论:女性VLS患者甲状腺功能或抗体异常的发生率较高,NLR能有效预测VLS患者继发甲状腺异常的发生,临床医生应当对VLS患者常规检测NLR水平。

Objective:To investigate the predictive value of neutrophil to lymphocyte ratio(NLR)in secondary thyroid abnormalities in female patients with vulvar lichen sclerosus(VLS).Methods:A total of 273 female patients with VLS were collected from January 2014 to June 2018.The follow-up was limited to patients secondary thyroid abnormalities or to Dec 31,2018.Female patients with thyroid abnormalities secondary to VLS were setted as observation group and others were setted as control group.The difference of thyroid hormone and antibody levels between the two groups were compared.Pearson correlation was used to analyze the correlation between NLR and vulvar leukoplakia area,thyroid hormone and antibody levels.The predictive value of NLR in female patients with thyroid abnormalities secondary to VLS was analyzed by ROC curve.Results:The average age of VLS patients was(42.17±8.65)years old.The lesions were mostly located to the labia and vaginal orifice,most of which showed depigmentation or hypopigmentation.The prevalence of thyroid abnormalities was 13.92%(38/273).The follow-up time of thyroid abnormalities after female patients diagnosed with VLS was(15.21±3.48)months,and most patients showed with high level of TPO-Ab and TSH.Pearson correlation analysis showed that NLR was positively correlated with leukoplakia area,TSH and TPO-Ab levels(r=0.232,0.531,0.499 respectively).ROC curve area of predicting NLR in female patients with thyroid abnormalities secondary to VLS was 0.906(95%CI:0.841~0.971)by ROC curve result.When NLR was 5.585,the Yoden index,sensitivity and specificity was 0.736,84.2%and 89.4%,respectively.Conclusions:The prevalence of thyroid dysfunction or antibody abnormalities in female patients with VLS is higher.NLR can effectively predict the occurrence of thyroid abnormalities in the female patients with VLS.Clinicians should routinely detect the level of NLR in patients with VLS.