支气管哮喘急性发作期血细胞比值的变化及临床意义
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摘要
目的探讨支气管哮喘急性发作期血细胞比值的变化及临床意义。方法选取2017年1月至2018年7月南京医科大学附属无锡人民医院收治的356例急性发作支气管哮喘患者作为病例组,选取同期1 481名体检合格者作为对照组,计算两组研究对象外周血血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)、嗜酸粒细胞/淋巴细胞比值(ELR)、嗜碱粒细胞/淋巴细胞比值(BLR)。结果病例组患者的PLR、NLR、MLR、ELR水平高于对照组[117. 50(86. 03,162. 05)比98. 09(79. 91,120. 53)、2. 28(1. 48,2. 97)比1. 65(1. 32,2. 06)、0. 28(0. 20,0. 42)比0. 19(0. 16,0. 23)、0. 11(0. 04,0. 23)比0. 05(0. 03,0. 08)](P <0. 01);哮喘合并肺部感染组患者的MLR水平高于单纯哮喘组[(0. 45±0. 26)比0. 28(0. 20,0. 42)](P <0. 05); PLR、NLR、MLR、ELR诊断支气管哮喘急性发作的受试者工作特征曲线下面积(AUC)分别为0. 629、0. 682、0. 732、0. 665,以MLR的AUC最高,灵敏度和特异度分别为0. 534和0. 877。MLR诊断支气管哮喘急性发作合并肺部感染的AUC为0. 655,灵敏度和特异度分别为0. 857和0. 532。结论支气管哮喘急性发作患者外周血淋巴细胞数量降低,PLR、MLR、NLR、ELR均升高,MLR可用于提示支气管哮喘的发作和合并肺部感染的发生,在疾病诊断中具有一定的辅助价值。
Objective To analyze the changes of blood cell ratio in peripheral blood in bronchial asthma during acute exacerbation and the clinical significance. Methods A total of 356 patients with acute exacerbation of bronchial asthma admitted to Wuxi People's Hospital Affiliated to Nanjing Medical University from Jan. 2017 to Jul. 2018 were enrolled as a case group,and 1 481 individuals with qualified physical examination results during the same period were included as a control group. The platelet-to-lymphocyte ratio( PLR),the neutrophil-to-lymphocyte ratio( NLR),the monocyte-tolymphocyte ratio( MLR),the eosinophil-to-lymphocyte ratio( ELR),the basophil-to-lymphocyte ratio( BLR) were computed and compared between the two groups. Results The levels of PLR,NLR,MLR,and ELR of the case group were higher than those in the control group[117. 50( 86. 03,162. 05) vs 98. 09( 79. 91,120. 53),2. 28( 1. 48,2. 97) vs 1. 65( 1. 32,2. 06),0. 28( 0. 20,0. 42) vs 0. 19( 0. 16,0. 23),0. 11( 0. 04,0. 23) vs 0. 05( 0. 03,0. 08) ]( P < 0. 01); the level of MLR in the patients with acute exacerbation complicated with pulmonary infections was higher than that in patients with simple asthma[( 0. 45 ± 0. 26) vs 0. 28( 0. 20,0. 42) ]( P < 0. 05). The area under receiver operating characteristic curve( AUC) of PLR,NLR,MLR and ELR in diagnosis of acute asthma attack were 0. 629,0. 682,0. 732 and 0. 665 respectively,and the sensitivity and the specificity were 0. 534 and 0. 877 respectively. The AUC of MLR in the diagnosis of acute asthma attack complicated with pulmonary infection was 0. 655( P < 0. 05),and the sensitivity and specificity were 0. 857 and 0. 532 respectively. Conclusion The levels of PLR,MLR,NLR and ELR in the peripheral blood of the patients with acute exacerbation attack of bronchial asthma are all up-regulated. MLR can be used to indicate the onset of asthma combined with pulmonary infections,which has certain auxiliary values in the diagnosis of the diseases.
Objective To analyze the changes of blood cell ratio in peripheral blood in bronchial asthma during acute exacerbation and the clinical significance. Methods A total of 356 patients with acute exacerbation of bronchial asthma admitted to Wuxi People's Hospital Affiliated to Nanjing Medical University from Jan. 2017 to Jul. 2018 were enrolled as a case group,and 1 481 individuals with qualified physical examination results during the same period were included as a control group. The platelet-to-lymphocyte ratio( PLR),the neutrophil-to-lymphocyte ratio( NLR),the monocyte-tolymphocyte ratio( MLR),the eosinophil-to-lymphocyte ratio( ELR),the basophil-to-lymphocyte ratio( BLR) were computed and compared between the two groups. Results The levels of PLR,NLR,MLR,and ELR of the case group were higher than those in the control group[117. 50( 86. 03,162. 05) vs 98. 09( 79. 91,120. 53),2. 28( 1. 48,2. 97) vs 1. 65( 1. 32,2. 06),0. 28( 0. 20,0. 42) vs 0. 19( 0. 16,0. 23),0. 11( 0. 04,0. 23) vs 0. 05( 0. 03,0. 08) ]( P < 0. 01); the level of MLR in the patients with acute exacerbation complicated with pulmonary infections was higher than that in patients with simple asthma[( 0. 45 ± 0. 26) vs 0. 28( 0. 20,0. 42) ]( P < 0. 05). The area under receiver operating characteristic curve( AUC) of PLR,NLR,MLR and ELR in diagnosis of acute asthma attack were 0. 629,0. 682,0. 732 and 0. 665 respectively,and the sensitivity and the specificity were 0. 534 and 0. 877 respectively. The AUC of MLR in the diagnosis of acute asthma attack complicated with pulmonary infection was 0. 655( P < 0. 05),and the sensitivity and specificity were 0. 857 and 0. 532 respectively. Conclusion The levels of PLR,MLR,NLR and ELR in the peripheral blood of the patients with acute exacerbation attack of bronchial asthma are all up-regulated. MLR can be used to indicate the onset of asthma combined with pulmonary infections,which has certain auxiliary values in the diagnosis of the diseases.
引文
[1]Zhang XY,Simpson JL,Powell H,et al.Full blood count parameters for the detection of asthma inflammatory phenotypes[J].Clin Exp Allergy,2014,44(9):1137-1145.
[2]Lin BD,Carnero-Montoro E,Bell JT,et al.2SNP heritability and effects of genetic variants for neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio[J].J Hum Genet,2017,62(11):979-988.
[3]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(2016年版)[J].中华结核和呼吸杂志,2016,39(9):675-697.
[4]Oliveira MA.Epidemiology of asthma:It is necessary to expand our concepts[J].J Bras Pneumol,2018,44(5):341-342.
[5]Sun Y,Hou J,Sheng Y,et al.Modern life makes children allergic.A cross-sectional study:Associations of home environment and lifestyles with asthma and allergy among children in Tianjin region,China[J].Int Arch Occup Environ Health,2019,92(4):587-598.
[6]Lai K,Shen H,Zhou X,et al.Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society(CTS)Asthma Consortium[J].J Thorac Dis,2018,10(11):6314-6351.
[7]Park JS,Son JH,Park CS,et al.Clinical implications of single nucleotide polymorphisms in diagnosis of asthma and its subtypes[J].Yonsei Med J,2019,60(1):1-9.
[8]Stevermer JJ,Hayes A.Should you reassess your patient's asthma diagnosis?[J].J Fam Pract,2018,67(11):704,706,707.
[9]王静怡,石运涛,周静芳,等.单核细胞与淋巴细胞比值对判断溃疡性结肠炎严重程度的意义[J].山西医科大学学报,2018,60(11):1351-1353.
[10]王熙智,秦海燕.单核细胞/高密度脂蛋白比值、单核细胞/淋巴细胞比值与非ST段抬高型心肌梗死及冠状动脉病变严重程度的关系研究[J].实用心脑肺血管病杂志,2018,26(10):18-23.
[11]张振宇,王婧,李海波.MLR、NLR对子痫前期诊断价值的研究[J].交通医学,2018,32(5):424-427,430.
[12]唐英,李均,徐凡,等.单核细胞与淋巴细胞比值及其与上皮性卵巢癌患者预后的关系[J/CD].中华妇幼临床医学杂志(电子版),2017,13(5):532-538.
[13]Cananzi FCM,Minerva EM,SamàL,et al.Preoperative monocyteto-lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors[J].J Surg Oncol,2019,119(1):12-20.
[14]周林福,王文璐,李红岩,等.支气管哮喘患者血清对内皮穿越模型中单核细胞分化为树突状细胞的作用[J].中华结核和呼吸杂志,2011,34(3):169-173.
[15]王淙垲,刘汉嘉,黄永智,等.哮喘患儿外周血单核细胞中Toll样受体4表达及意义[J].中华实用诊断与治疗杂志,2015,29(12):1212-1214.
[16]蔡鹏程,魏燕,胡丽华.TIM4在过敏性哮喘患者单核细胞和哮喘小鼠模型肺组织表达增高[J].中国组织化学与细胞化学杂志,2015,24(5):443-446,456.
[17]陈瑩,周张青,唐猛.外周血NLR在评估重度支气管哮喘急性发作期患者预后的中的意义[J].浙江临床医学,2018,20(4):717-719.
[18]张晓雪,程广坤,郭辉,等.外周血NLR、PLR、LMR在小儿支气管哮喘辅助诊断中的价值及临床意义[J].国际检验医学杂志,2019,39(2):214-217,221.
[19]盖晓燕,常春,王娟,等.中性粒细胞型哮喘患者的气道炎症与小气道重构分析[J].北京大学学报(医学版),2018,60(4):645-650.
[20]姚彤,郭红,陈若华.76例哮喘儿童气道炎症表型分析[J].新疆医科大学学报,2018,41(2):153-157,165.
[21]沈美珠,夏元旦,周敏,等.老年支气管哮喘患者临床表现及炎症特征分析[J].老年医学与保健,2018,24(2):191-194.
[22]郭维丽,李敏超.冷刺激敏感哮喘患者的临床及炎症表型特点[J].南方医科大学学报,2019,39(2):181-185.
[23]Antwi-Baffour S,Kyeremeh R,Buabeng D,et al.Correlation of malaria parasitaemia with peripheral blood monocyte to lymphocyte ratio as indicator of susceptibility to severe malaria in Ghanaian children[J].Malar J,2018,17(1):419.
[24]Choudhary RK,Wall KM,Njuguna I,et al.Monocyte-to-lymphocyte ratio is associated with tuberculosis disease and declines with anti-TB treatment in HIV-infected children[J].J Acquir Immune Defic Syndr,2019,80(2):174-181.
[25]王辉,张佳莹,杨梦媛,等.外周血单核细胞与淋巴细胞比值与急性胰腺炎严重程度及预后关系研究[J].中国中西医结合消化杂志,2019,27(2):128-132,138.
[26]董嘉琤,梁官钊,刘维达.血单核细胞在真菌感染免疫的研究进展[J].中国真菌学杂志,2018,13(4):244-246.
[2]Lin BD,Carnero-Montoro E,Bell JT,et al.2SNP heritability and effects of genetic variants for neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio[J].J Hum Genet,2017,62(11):979-988.
[3]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(2016年版)[J].中华结核和呼吸杂志,2016,39(9):675-697.
[4]Oliveira MA.Epidemiology of asthma:It is necessary to expand our concepts[J].J Bras Pneumol,2018,44(5):341-342.
[5]Sun Y,Hou J,Sheng Y,et al.Modern life makes children allergic.A cross-sectional study:Associations of home environment and lifestyles with asthma and allergy among children in Tianjin region,China[J].Int Arch Occup Environ Health,2019,92(4):587-598.
[6]Lai K,Shen H,Zhou X,et al.Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society(CTS)Asthma Consortium[J].J Thorac Dis,2018,10(11):6314-6351.
[7]Park JS,Son JH,Park CS,et al.Clinical implications of single nucleotide polymorphisms in diagnosis of asthma and its subtypes[J].Yonsei Med J,2019,60(1):1-9.
[8]Stevermer JJ,Hayes A.Should you reassess your patient's asthma diagnosis?[J].J Fam Pract,2018,67(11):704,706,707.
[9]王静怡,石运涛,周静芳,等.单核细胞与淋巴细胞比值对判断溃疡性结肠炎严重程度的意义[J].山西医科大学学报,2018,60(11):1351-1353.
[10]王熙智,秦海燕.单核细胞/高密度脂蛋白比值、单核细胞/淋巴细胞比值与非ST段抬高型心肌梗死及冠状动脉病变严重程度的关系研究[J].实用心脑肺血管病杂志,2018,26(10):18-23.
[11]张振宇,王婧,李海波.MLR、NLR对子痫前期诊断价值的研究[J].交通医学,2018,32(5):424-427,430.
[12]唐英,李均,徐凡,等.单核细胞与淋巴细胞比值及其与上皮性卵巢癌患者预后的关系[J/CD].中华妇幼临床医学杂志(电子版),2017,13(5):532-538.
[13]Cananzi FCM,Minerva EM,SamàL,et al.Preoperative monocyteto-lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors[J].J Surg Oncol,2019,119(1):12-20.
[14]周林福,王文璐,李红岩,等.支气管哮喘患者血清对内皮穿越模型中单核细胞分化为树突状细胞的作用[J].中华结核和呼吸杂志,2011,34(3):169-173.
[15]王淙垲,刘汉嘉,黄永智,等.哮喘患儿外周血单核细胞中Toll样受体4表达及意义[J].中华实用诊断与治疗杂志,2015,29(12):1212-1214.
[16]蔡鹏程,魏燕,胡丽华.TIM4在过敏性哮喘患者单核细胞和哮喘小鼠模型肺组织表达增高[J].中国组织化学与细胞化学杂志,2015,24(5):443-446,456.
[17]陈瑩,周张青,唐猛.外周血NLR在评估重度支气管哮喘急性发作期患者预后的中的意义[J].浙江临床医学,2018,20(4):717-719.
[18]张晓雪,程广坤,郭辉,等.外周血NLR、PLR、LMR在小儿支气管哮喘辅助诊断中的价值及临床意义[J].国际检验医学杂志,2019,39(2):214-217,221.
[19]盖晓燕,常春,王娟,等.中性粒细胞型哮喘患者的气道炎症与小气道重构分析[J].北京大学学报(医学版),2018,60(4):645-650.
[20]姚彤,郭红,陈若华.76例哮喘儿童气道炎症表型分析[J].新疆医科大学学报,2018,41(2):153-157,165.
[21]沈美珠,夏元旦,周敏,等.老年支气管哮喘患者临床表现及炎症特征分析[J].老年医学与保健,2018,24(2):191-194.
[22]郭维丽,李敏超.冷刺激敏感哮喘患者的临床及炎症表型特点[J].南方医科大学学报,2019,39(2):181-185.
[23]Antwi-Baffour S,Kyeremeh R,Buabeng D,et al.Correlation of malaria parasitaemia with peripheral blood monocyte to lymphocyte ratio as indicator of susceptibility to severe malaria in Ghanaian children[J].Malar J,2018,17(1):419.
[24]Choudhary RK,Wall KM,Njuguna I,et al.Monocyte-to-lymphocyte ratio is associated with tuberculosis disease and declines with anti-TB treatment in HIV-infected children[J].J Acquir Immune Defic Syndr,2019,80(2):174-181.
[25]王辉,张佳莹,杨梦媛,等.外周血单核细胞与淋巴细胞比值与急性胰腺炎严重程度及预后关系研究[J].中国中西医结合消化杂志,2019,27(2):128-132,138.
[26]董嘉琤,梁官钊,刘维达.血单核细胞在真菌感染免疫的研究进展[J].中国真菌学杂志,2018,13(4):244-246.