血小板和中性粒细胞与淋巴细胞比值辅助诊断克罗恩病的价值评价
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摘要
目的回顾性分析克罗恩病(Crohn's disease,CD)患者和健康对照者血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)和中性粒细胞/淋巴细胞比值(neutrophilto-lymphocyte ratio,NLR)结果,评价二者在CD的诊断价值.方法纳入60例CD患者和60例健康对照,抽取EDTA抗凝静脉血做血常规检测,分别得到中性粒细胞计数绝对值、淋巴细胞计数绝对值和血小板计数值,经计算得出PLR和NLR.统计学分析和绘制受试者工作曲线(receiver operator characteristic curve,ROC曲线),得出灵敏度(sensitivity,Sen)和特异度(specificity,Spe)和cut-off值.结果与健康对照组相比,PLR和NLR在CD患者中高表达,分别为(181±45.12 vs 86±32.78和3.07±1.02 vs 2.52±1.14),差异有统计学意义(P<0.05),PLR和NLR诊断CD病的ROC曲线下面积分别为0.764和0.828;对应的Sen、Spe和cut-off值分别为:PLR(Sen:76.21%,Spe:84.53%,cut-off值:133.12);NLR(Sen:69.16%,Spe:76.24%,cut-off值:2.85).结论 PLR和NLR辅助诊断CD具有潜在的诊断价值,有望成为廉价、快速的诊断标志.
AIM to investigate the diagnostic efficacy of platelet-tolymphocyte ratio(PLR) and neutrophil-to-lymphocyte ratio(NLR) in patients with Crohn's disease(CD).METHODS EDTA anticoagulant venous blood was collected from CD patients(n = 60) and healthy controls(n = 60),and routine blood test was performed to obtain the neutrophilic granulocyte count, lymphocyte count,and platelet count. Then, the PLR and NLR were calculated. The sensitivity(Sen), specificity(Spe), and cut-off values were calculated by receiver operator characteristic(ROC) curve analysis.RESULTS CD patients had significantly higher PLR(181 ± 45.12 vs 86 ± 32.78) and NLR(3.07 ± 1.02 vs 2.52 ± 1.14) than healthy controls(P < 0.05). The cut-off values for PLR and NLR were 133.12(Sen: 76.21%; Spe: 84.53%) and2.85(Sen: 69.16%; Spe: 76.24%), respectively, and the areas under the ROC curves for PLR and NLR were 0.764 and 0.828, respectively.CONCLUSION PLR and NLR might be effective and low-cost biomarkers for distinguishing CD patients from healthy controls.
AIM to investigate the diagnostic efficacy of platelet-tolymphocyte ratio(PLR) and neutrophil-to-lymphocyte ratio(NLR) in patients with Crohn's disease(CD).METHODS EDTA anticoagulant venous blood was collected from CD patients(n = 60) and healthy controls(n = 60),and routine blood test was performed to obtain the neutrophilic granulocyte count, lymphocyte count,and platelet count. Then, the PLR and NLR were calculated. The sensitivity(Sen), specificity(Spe), and cut-off values were calculated by receiver operator characteristic(ROC) curve analysis.RESULTS CD patients had significantly higher PLR(181 ± 45.12 vs 86 ± 32.78) and NLR(3.07 ± 1.02 vs 2.52 ± 1.14) than healthy controls(P < 0.05). The cut-off values for PLR and NLR were 133.12(Sen: 76.21%; Spe: 84.53%) and2.85(Sen: 69.16%; Spe: 76.24%), respectively, and the areas under the ROC curves for PLR and NLR were 0.764 and 0.828, respectively.CONCLUSION PLR and NLR might be effective and low-cost biomarkers for distinguishing CD patients from healthy controls.
引文
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11 Akboga MK,Canpolat U,Yuksel M,Yayla C,Yilmaz S,Turak O,Ozeke O,Topaloglu S,Aras D.Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome:A single center largescale study.Platelets 2016;27:178-183[PMID:26196312 DOI:10.3109/09537104.2015.1064518]
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13 Wang X,Xie Z,Liu X,Huang X,Lin J,Huang D,Yu B,Hou J.Association of Platelet to lymphocyte ratio with nonculprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome:an optical coherence tomography study.BMC Cardiovasc Disord 2017;17:175[PMID:28673240 DOI:10.1186/s12872-017-0618-y]
14 Zhao Z,Liu J,Wang J,Xie T,Zhang Q,Feng S,Deng H,Zhong B.Platelet-to-lymphocyte ratio(PLR)and neutrophiltolymphocyte ratio(NLR)are associated with chronic hepatitis B virus(HBV)infection.Int Immunopharmacol 2017;51:1-8[PMID:28759808 DOI:10.1016/j.intimp.2017.07.007]
15 Yang HJ,Jiang JH,Liu QA,Zhou CM,Du YF,Wu T,Chen NZ,Xiang BD.Preoperative platelet-to-lymphocyte ratio is a valuable prognostic biomarker in patients with hepatocellular carcinoma undergoing curative liver resection.Tumour Biol 2017;39:1010428317707375[PMID:28639906 DOI:10.1177/1010428317707375]
16 Tang J,Gao X,Zhi M,Zhou HM,Zhang M,Chen HW,Yang QF,Liang ZZ.Plateletcrit:a sensitive biomarker for evaluating disease activity in Crohn’s disease with low hs-CRP.J Dig Dis 2015;16:118-124[PMID:25565427 DOI:10.1111/1751-2980.12225]
17 Li X,Shen J,Lu Z,Chen M,Fang X,Wang G.High neutrophil-to-lymphocyte ratio is associated with increased carotid artery intima-media thickness in type 2 diabetes.J Diabetes Investig 2017;8:101-107[PMID:27220111 DOI:10.1111/jdi.12541]
18 Piciucchi M,Stigliano S,Archibugi L,Zerboni G,Signoretti M,Barucca V,Valente R,Fave GD,Capurso G.The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients.Int J Mol Sci 2017;18:pii E730[PMID:28353661 DOI:10.3390/ijms18040730]
19 Goksugur SB,Kabakus N,Bekdas M,Demircioglu F.Neutr ophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types.Eur Rev Med Pharmacol Sci 2014;18:3380-3385[PMID:25491611]
20胡品津.炎症性肠病诊断与治疗的共识意见(2012年?广州)解读.胃肠病学2012;17:709-711
21 Wang Z,Wang Z,Wang J,Diao Y,Qian X,Zhu N.T-betExpressing B Cells Are Positively Associated with Crohn's Disease Activity and Support Th1 Inflammation.DNACell Biol 2016;35:628-635[PMID:27348235 DOI:10.1089/dna.2016.3304]
22 Ye L,Zhang YP,Yu N,Jia YX,Wan SJ,Wang FY.Serum platelet factor 4 is a reliable activity parameter in adult patients with inflammatory bowel disease:A pilot study.Medicine(Baltimore)2017;96:e6323[PMID:28296751 DOI:10.1097/MD.0000000000006323]
23 Gao SQ,Huang LD,Dai RJ,Chen DD,Hu WJ,Shan YF.Neutrophil-lymphocyte ratio:a controversial marker in predicting Crohn’s disease severity.Int J Clin Exp Pathol2015;8:14779-14785[PMID:26823804]
2 Stange EF,Wehkamp J.Recent advances in understanding and managing Crohn’s disease.F1000Res 2016;5:2896[PMID:28163902 DOI:10.12688/f1000research.9890.1]
3 Troiano G,Dioguardi M,Limongelli L,Tempesta A,Favia G,Giuliani M,Sanguedolce F,Lo Muzio L.Can Inspection of the Mouth Help Clinicians Diagnose Crohn’s Disease?A Review.Oral Health Prev Dent 2017;15:223-227[PMID:28530005 DOI:10.3290/j.ohpd.a38158]
4 Maconi G,Magro F.Comparing techniques to achieve high accuracy and low cost:how should we first diagnose Crohn’s disease?J Comp Eff Res 2015;4:75-78[PMID:25825838 DOI:10.2217/cer.15.2]
5 Mosli MH,Zou G,Garg SK,Feagan SG,MacDonald JK,Chande N,Sandborn WJ,Feagan BG.C-Reactive Protein,Fecal Calprotectin,and Stool Lactoferrin for Detection of Endoscopic Activity in Symptomatic Inflammatory Bowel Disease Patients:A Systematic Review and Meta-Analysis.Am J Gastroenterol 2015;110:802-819;quiz 820[PMID:25964225 DOI:10.1038/ajg.2015.120]
6 T ran DH,Wang J,Ha C,Ho W,Mattai SA,Oikonomopoulos A,Weiss G,Lacey P,Cheng M,Shieh C,Mussatto CC,Ho S,Hommes D,Koon HW.Circulating cathelicidin levels correlate with mucosal disease activity in ulcerative colitis,risk of intestinal stricture in Crohn’s disease,and clinical prognosis in inflammatory bowel disease.BMCGastroenterol 2017;17:63[PMID:28494754 DOI:10.1186/s12876-017-0619-4]
7 Ye L,Chen W,Chen BQ,Lan X,Wang SD,Wu XC,Huang W,Wang FY.Levels of Faecal Calprotectin and Magnetic Resonance Enterocolonography Correlate with Severity of Small Bowel Crohn’s Disease:A Retrospective Cohort Study.Sci Rep 2017;7:1970[PMID:28512287 DOI:10.1038/s41598-017-02111-6]
8 Govani SM,Waljee AK,Kocher KE,Swoger JM,Saul M,Higgins PD.Validation of a tool predicting important findings on computed tomography among Crohn’s disease patients.United European Gastroenterol J 2017;5:270-275[PMID:28344795 DOI:10.1177/2050640616658218]
9 Curbelo J,Luquero Bueno S,Galván-Román JM,OrtegaGómez M,Rajas O,Fernández-Jiménez G,Vega-Piris L,Rodríguez-Salvanes F,Arnalich B,Díaz A,Costa R,de la Fuente H,Lanchoá,Suárez C,Ancochea J,Aspa J.Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients:Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.PLoS One 2017;12:e0173947[PMID:28301543 DOI:10.1371/journal.pone.0173947]
10 Yilmaz G,Sevinc C,Ustundag S,Yavuz YC,Hac齜ekiroglu T,Hatipoglu E,Baysal M.The relationship between mean platelet volume and neutrophil/lymphocyte ratio with inflammation and proteinuria in chronic kidney disease.Saudi J Kidney Dis Transpl 2017;28:90-94[PMID:28098108DOI:10.4103/1319-2442.198152]
11 Akboga MK,Canpolat U,Yuksel M,Yayla C,Yilmaz S,Turak O,Ozeke O,Topaloglu S,Aras D.Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome:A single center largescale study.Platelets 2016;27:178-183[PMID:26196312 DOI:10.3109/09537104.2015.1064518]
12 Akbas EM,Gungor A,Ozcicek A,Akbas N,Askin S,Polat M.Vitamin D and inflammation:evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio.Arch Med Sci 2016;12:721-727[PMID:27478451 DOI:10.5114/aoms.2015.50625]
13 Wang X,Xie Z,Liu X,Huang X,Lin J,Huang D,Yu B,Hou J.Association of Platelet to lymphocyte ratio with nonculprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome:an optical coherence tomography study.BMC Cardiovasc Disord 2017;17:175[PMID:28673240 DOI:10.1186/s12872-017-0618-y]
14 Zhao Z,Liu J,Wang J,Xie T,Zhang Q,Feng S,Deng H,Zhong B.Platelet-to-lymphocyte ratio(PLR)and neutrophiltolymphocyte ratio(NLR)are associated with chronic hepatitis B virus(HBV)infection.Int Immunopharmacol 2017;51:1-8[PMID:28759808 DOI:10.1016/j.intimp.2017.07.007]
15 Yang HJ,Jiang JH,Liu QA,Zhou CM,Du YF,Wu T,Chen NZ,Xiang BD.Preoperative platelet-to-lymphocyte ratio is a valuable prognostic biomarker in patients with hepatocellular carcinoma undergoing curative liver resection.Tumour Biol 2017;39:1010428317707375[PMID:28639906 DOI:10.1177/1010428317707375]
16 Tang J,Gao X,Zhi M,Zhou HM,Zhang M,Chen HW,Yang QF,Liang ZZ.Plateletcrit:a sensitive biomarker for evaluating disease activity in Crohn’s disease with low hs-CRP.J Dig Dis 2015;16:118-124[PMID:25565427 DOI:10.1111/1751-2980.12225]
17 Li X,Shen J,Lu Z,Chen M,Fang X,Wang G.High neutrophil-to-lymphocyte ratio is associated with increased carotid artery intima-media thickness in type 2 diabetes.J Diabetes Investig 2017;8:101-107[PMID:27220111 DOI:10.1111/jdi.12541]
18 Piciucchi M,Stigliano S,Archibugi L,Zerboni G,Signoretti M,Barucca V,Valente R,Fave GD,Capurso G.The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients.Int J Mol Sci 2017;18:pii E730[PMID:28353661 DOI:10.3390/ijms18040730]
19 Goksugur SB,Kabakus N,Bekdas M,Demircioglu F.Neutr ophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types.Eur Rev Med Pharmacol Sci 2014;18:3380-3385[PMID:25491611]
20胡品津.炎症性肠病诊断与治疗的共识意见(2012年?广州)解读.胃肠病学2012;17:709-711
21 Wang Z,Wang Z,Wang J,Diao Y,Qian X,Zhu N.T-betExpressing B Cells Are Positively Associated with Crohn's Disease Activity and Support Th1 Inflammation.DNACell Biol 2016;35:628-635[PMID:27348235 DOI:10.1089/dna.2016.3304]
22 Ye L,Zhang YP,Yu N,Jia YX,Wan SJ,Wang FY.Serum platelet factor 4 is a reliable activity parameter in adult patients with inflammatory bowel disease:A pilot study.Medicine(Baltimore)2017;96:e6323[PMID:28296751 DOI:10.1097/MD.0000000000006323]
23 Gao SQ,Huang LD,Dai RJ,Chen DD,Hu WJ,Shan YF.Neutrophil-lymphocyte ratio:a controversial marker in predicting Crohn’s disease severity.Int J Clin Exp Pathol2015;8:14779-14785[PMID:26823804]