中性粒细胞/淋巴细胞比值及血小板/淋巴细胞比值在溃疡性结肠炎病情评估中的临床价值
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摘要
目的探讨中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR)在溃疡性结肠炎(ulcerative colitis,UC)患者病情判断中的价值,比较NLR、PLR及临床常用炎症指标评估UC患者病情的效能。方法收集2015年1月至2018年1月于武汉大学人民医院消化内科住院的UC患者148例,另选取同期肠易激综合征(irritable bowel syndrome,IBS)患者42例作为对照组。收集研究对象临床资料,依据病史、改良Mayo活动指数及蒙特利尔分级对所有UC患者临床类型、活动性及病变范围进行分组。回顾性分析NLR及PLR在不同临床类型、活动性及病变范围的研究对象中的差异,同时与常用指标白细胞(white blood cell,WBC)、中性粒细胞(neutrophil,N)、C反应蛋白(C-reaction protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、血小板(platelet,PLT)进行比较。结果 NLR及PLR在UC患者外周血水平均高于对照组,NLR在不同的临床类型、活动性、病变范围的UC患者中差异均有统计学意义(P<0.05); PLR仅在不同活动性UC患者中差异有统计学意义(P<0.05)。NLR用于评估UC活动性的cut-off值为2.255,敏感性和特异性分别为79.21%、61.70%,诊断价值(AUC=0.721,95%CI:0.630～0.812);PLR评估UC活动性的cut-off值为171.2,敏感性与特异性分别为51.49%、78.72%,诊断价值(AUC=0.665,95%CI:0.577～0.754),二者均优于WBC(AUC=0.628,95%CI:0.531～0.725)、N(AUC=0.657,95%CI:0.559～0.754)及CRP(AUC=0.662,95%CI:0.572～0.753),NLR诊断价值优于ESR(AUC=0.705,95%CI:0.613～0.798),而PLR逊于ESR。结论 NLR及PLR在活动期UC患者中升高。外周血NLR及PLR可以反映疾病活动情况,可以用作估计UC患者肠道炎症简易的额外标志物。
Objective To explore the value of NLR and PLR in the assessment of patients with ulcerative colitis(UC), the efficacy of NLR, PLR and clinical commonly used inflammation indicators were compared to evaluate the condition of patients with UC. Methods A total of 148 patients with UC admitted to the Department of Gastroenterology, Wuhan University Renmin Hospital from Jan. 2015 to Jan. 2018 were enrolled. Forty-two patients with irritable bowel syndrome(IBS) were selected as control group. The clinical data of the subjects were collected, and the clinical types, activities, and lesions of all UC patients were grouped according to the medical history, modified Mayo activity index, and Montreal classification. Retrospective analysis of differences in NLR and PLR among subjects with different clinical types, activities, and lesions, and the conventional inflammatory markers WBC, N, CRP, ESR and PLT were compared. Results The peripheral blood levels of NLR and PLR in UC patients were higher than those in the control group. NLR was significantly different in UC patients with disparate clinical types, activity, and location(P<0.05); the difference of PLR was significant in the UC patients with different activity(P<0.05). The cut-off value of NLR for assessing UC activity was 2.255, sensitivity and specificity were 79.21%, 61.70%, and diagnostic value was(AUC=0.721,95% CI: 0.630-0.812); PLR assessed UC activity. The cut-off value was 171.2, and the sensitivity and specificity were 51.49%, 78.72%, the diagnostic value was AUC=0.665, 95% CI: 0.577-0.754, both of which were superior to WBC(AUC=0.628, 95% CI: 0.531-0.725), N(AUC=0.657, 95% CI: 0.559-0.754) and CRP(AUC=0.662, 95% CI: 0.572-0.753), NLR diagnostic value was better than ESR(AUC=0.705, 95% CI: 0.613-0.798), while PLR was worse than ESR. Conclusion NLR and PLR increased in patients with active UC. Peripheral blood NLR and PLR can reflect disease activity and can be used as an additional marker to estimate the intestinal inflammation in UC patients.
Objective To explore the value of NLR and PLR in the assessment of patients with ulcerative colitis(UC), the efficacy of NLR, PLR and clinical commonly used inflammation indicators were compared to evaluate the condition of patients with UC. Methods A total of 148 patients with UC admitted to the Department of Gastroenterology, Wuhan University Renmin Hospital from Jan. 2015 to Jan. 2018 were enrolled. Forty-two patients with irritable bowel syndrome(IBS) were selected as control group. The clinical data of the subjects were collected, and the clinical types, activities, and lesions of all UC patients were grouped according to the medical history, modified Mayo activity index, and Montreal classification. Retrospective analysis of differences in NLR and PLR among subjects with different clinical types, activities, and lesions, and the conventional inflammatory markers WBC, N, CRP, ESR and PLT were compared. Results The peripheral blood levels of NLR and PLR in UC patients were higher than those in the control group. NLR was significantly different in UC patients with disparate clinical types, activity, and location(P<0.05); the difference of PLR was significant in the UC patients with different activity(P<0.05). The cut-off value of NLR for assessing UC activity was 2.255, sensitivity and specificity were 79.21%, 61.70%, and diagnostic value was(AUC=0.721,95% CI: 0.630-0.812); PLR assessed UC activity. The cut-off value was 171.2, and the sensitivity and specificity were 51.49%, 78.72%, the diagnostic value was AUC=0.665, 95% CI: 0.577-0.754, both of which were superior to WBC(AUC=0.628, 95% CI: 0.531-0.725), N(AUC=0.657, 95% CI: 0.559-0.754) and CRP(AUC=0.662, 95% CI: 0.572-0.753), NLR diagnostic value was better than ESR(AUC=0.705, 95% CI: 0.613-0.798), while PLR was worse than ESR. Conclusion NLR and PLR increased in patients with active UC. Peripheral blood NLR and PLR can reflect disease activity and can be used as an additional marker to estimate the intestinal inflammation in UC patients.
引文
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[14] DJORDJEVIC D, RONDOVIC G, SURBATOVIC M, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically Ⅲ and injured patients: which ratio to choose to predict outcome and nature of bacteremia? [J]. Mediators Inflamm, 2018, 2018: 3758068. DOI: 10.1155/2018/3758068.
[15] BOZAN N, ALPAYCI M, ASLAN M, et al. Mean platelet volume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds [J]. Eur Arch Otorhinolaryngol, 2016, 273(11): 3663-3672. DOI: 10.1007/s00405-016-3980-y.
[16] QIN B, MA N, TANG Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients [J]. Mod Rheumatol, 2016, 26(3): 372-376. DOI: 10.3109/14397595.2015.1091136.
[17] GüL? M, A?AN A F. Relationship of peripheral blood neutrophil to lymphocyte ratio and irritable bowel syndrome [J]. Turk J Med Sci, 2017, 47(4): 1067-1071. DOI: 10.3906/sag-1509-44.
[18] WéRA O, LANCELLOTTI P, OURY C. The dual role of neutrophils in inflammatory bowel diseases [J]. J Clin Med, 2016, 5(12). pii: E118. DOI: 10.3390/jcm5120118.
[19] NAKARAI A, KATO J, HIRAOKA S, et al. An elevated platelet count increases the risk of relapse in ulcerative colitis patients with mucosal healing [J]. Gut Liver, 2018, 12(4): 420-425. DOI: 10.5009/gnl17236.
[20] RIZVI M, PATHAK D, FREEDMAN J E, et al. CD40-CD40 ligand interactions in oxidative stress, inflammation and vascular disease [J]. Trends Mol Med, 2008, 14(12): 530-538. DOI: 10.1016/j.molmed.2008.09.006.
[21] DANESE S, KATZ J A, SAIBENI S, et al. Activated platelets are the source of elevated levels of soluble CD40 ligand in the circulation of inflammatory bowel disease patients [J]. Gut, 2003, 52(10): 1435-1441.
[22] KAYO S, IKURA Y, SUEKANE T, et al. Close association between activated platelets and neutrophils in the active phase of ulcerative colitis in humans [J]. Inflamm Bowel Dis, 2006, 12(8): 727-735.
[23] SATO H, HIGASHIYAMA M, HOZUMI H, et al. Platelet interaction with lymphatics aggravates intestinal inflammation by suppressing lymphangiogenesis [J]. Am J Physiol Gastrointest Liver Physiol, 2016, 311(2): G276-G285. DOI: 10.1152/ajpgi.00455.2015.
[2] CAPRILLI R, VISCIDO A, LATELLA G. Current management of severe ulcerative colitis [J]. Nat Clin Pract Gastroenterol Hepatol, 2007, 4(2): 92-101. DOI: 10.1038/ncpgasthep0687.
[3] KIM T G, PARK W, KIM H, et al. Baseline neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in rectal cancer patients following neoadjuvant chemoradiotherapy [J]. Tumori, 2018, 17: 300891618792476. DOI: 10.1177/0300891618792476.
[4] LEE B M, CHUNG S Y, CHANG J S, et al. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are prognostic factors in patients with locally advanced pancreatic cancer treated with chemoradiotherapy [J]. Gut Liver, 2018, 12(3): 342-352. DOI: 10.5009/gnl17216.
[5] KURTIPEK E, BEKCI T T, KESLI R, et al. The role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease [J]. J Pak Med Assoc, 2015, 65(12): 1283-1287.
[6] ZAHOREC R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill [J]. Bratisl Lek Listy, 2001, 102(1): 5-14.
[7] POSUL E, YILMAZ B, AKTAS G, et al. Does neutrophil-to-lymphocyte ratio predict active ulcerative colitis? [J]. Wien Klin Wochenschr, 2015, 127(7-8): 262-265. DOI: 10.1007/s00508-014-0683-5.
[8] GAO S Q, HUANG L D, DAI R J, et al. Neutrophil-lymphocyte ratio: a controversial marker in predicting Crohn’s disease severity [J]. Int J Clin Exp Pathol, 2015, 8(11): 14779-14785.
[9] 炎症性肠病诊断与治疗的共识意见(2012年·广州) [J]. 胃肠病学, 2012, 17(12): 763-781. DOI: 10.3969/j.issn.1008-7125.2012.12.013.
[10] DROSSMAN D A. The functional gastrointestinal disorders and the Rome Ⅲ process [J]. Gastroenterology, 2006, 130(5): 1377-1390. DOI: 10.1053/j.gastro.2006.03.008.
[11] D’HAENS G, SANDBORN W J, FEAGAN B G, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis [J]. Gastroenterology, 2007, 132(2): 763-786. DOI: 10.1053/j.gastro.2006.12.038.
[12] SATSANGI J, SILVERBERG M S, VERMEIRE S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications [J]. Gut, 2006, 55(6): 749-753. DOI: 10.1136/gut.2005.082909.
[13] KAYA H, ERTAS F, SOYDIN? M S. Association between neutrophil to lymphocyte ratio and severity of coronary artery disease [J]. Clin Appl Thromb Hemost, 2014, 20(2): 221. DOI: 10.1177/1076029613499821 .
[14] DJORDJEVIC D, RONDOVIC G, SURBATOVIC M, et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically Ⅲ and injured patients: which ratio to choose to predict outcome and nature of bacteremia? [J]. Mediators Inflamm, 2018, 2018: 3758068. DOI: 10.1155/2018/3758068.
[15] BOZAN N, ALPAYCI M, ASLAN M, et al. Mean platelet volume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds [J]. Eur Arch Otorhinolaryngol, 2016, 273(11): 3663-3672. DOI: 10.1007/s00405-016-3980-y.
[16] QIN B, MA N, TANG Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients [J]. Mod Rheumatol, 2016, 26(3): 372-376. DOI: 10.3109/14397595.2015.1091136.
[17] GüL? M, A?AN A F. Relationship of peripheral blood neutrophil to lymphocyte ratio and irritable bowel syndrome [J]. Turk J Med Sci, 2017, 47(4): 1067-1071. DOI: 10.3906/sag-1509-44.
[18] WéRA O, LANCELLOTTI P, OURY C. The dual role of neutrophils in inflammatory bowel diseases [J]. J Clin Med, 2016, 5(12). pii: E118. DOI: 10.3390/jcm5120118.
[19] NAKARAI A, KATO J, HIRAOKA S, et al. An elevated platelet count increases the risk of relapse in ulcerative colitis patients with mucosal healing [J]. Gut Liver, 2018, 12(4): 420-425. DOI: 10.5009/gnl17236.
[20] RIZVI M, PATHAK D, FREEDMAN J E, et al. CD40-CD40 ligand interactions in oxidative stress, inflammation and vascular disease [J]. Trends Mol Med, 2008, 14(12): 530-538. DOI: 10.1016/j.molmed.2008.09.006.
[21] DANESE S, KATZ J A, SAIBENI S, et al. Activated platelets are the source of elevated levels of soluble CD40 ligand in the circulation of inflammatory bowel disease patients [J]. Gut, 2003, 52(10): 1435-1441.
[22] KAYO S, IKURA Y, SUEKANE T, et al. Close association between activated platelets and neutrophils in the active phase of ulcerative colitis in humans [J]. Inflamm Bowel Dis, 2006, 12(8): 727-735.
[23] SATO H, HIGASHIYAMA M, HOZUMI H, et al. Platelet interaction with lymphatics aggravates intestinal inflammation by suppressing lymphangiogenesis [J]. Am J Physiol Gastrointest Liver Physiol, 2016, 311(2): G276-G285. DOI: 10.1152/ajpgi.00455.2015.