| 摘要: |
| 目的 探讨中性粒细胞与淋巴细胞比值（NLR）和皮肌炎（DM）诊断及疾病活动度的关系。方法 回顾性分析2016年1月至2019年12月于海军军医大学（第二军医大学）长征医院及长海医院风湿免疫科初次住院治疗的50例DM患者的临床及实验室资料，选择同期31名健康体检者、26例类风湿关节炎（RA）患者和27例强直性脊柱炎（AS）患者作为对照。采用Mann-Whitney U检验比较DM患者与健康对照、RA患者、AS患者NLR，采用Spearman秩相关分析研究NLR与肌酸激酶（CK）、乳酸脱氢酶（LDH）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、CRP、红细胞沉降率（ESR）的相关性。绘制ROC曲线评估NLR对DM的诊断效能，AUC的比较采用Z检验。采用配对Wilcoxon符号秩检验比较DM患者治疗前后NLR、CK、AST、ALT和LDH的变化。结果 DM、RA和AS患者NLR均高于健康对照（U=29.0、156.0、194.0，P均<0.01），DM患者NLR高于RA和AS患者（U=333.0、213.0，P均<0.01）。Spearman秩相关分析结果显示，DM患者的NLR与CK、LDH、AST、ALT、CRP和ESR均呈正相关（rs=0.540、0.288、0.440、0.498、0.304、0.311，P均<0.05）。NLR、LDH、CK、ALT、AST诊断DM的ROC AUC分别为0.981、0.954、0.931、0.913、0.867，最佳截断值分别为2.824、241.0 U/L、101.0 U/L、25.50 U/L、30.00 U/L，NLR诊断DM的ROC AUC高于ALT与AST（Z=2.05、2.67，P=0.040、0.008），其他各指标诊断DM的ROC AUC差异均无统计学意义（P均>0.05）。治疗后DM患者NLR与CK、AST、ALT和LDH水平均较治疗前下降（Z=3.28、4.68、4.62、2.12、4.44，P均<0.05）。结论 NLR可用于判断DM疾病活动度及严重程度，且对诊断及预测治疗反应具有一定的临床价值。 |
| 关键词: 中性粒细胞与淋巴细胞比值 皮肌炎 疾病活动度 肌酸激酶 |
| DOI：10.16781/j.0258-879x.2020.03.0292 |
| 投稿时间：2020-01-06修订日期：2020-02-12 |
| 基金项目:国家自然科学基金（81801620）. |
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| Correlation between neutrophil-lymphocyte ratio and dermatomyositis |
| GAO Li-hong1,LIU Xin1,CHEN Ya-bing2,XU Hu-ji1* |
(1. Department of Rheumatology and Immunology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Rheumatology and Immunology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the correlation between neutrophil-lymphocyte ratio (NLR) and diagnosis and disease activity of dermatomyositis (DM). Methods The clinical and laboratory data of 50 DM patients, who were admitted for the first time in Changzheng Hospital or Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Dec. 2019, were retrospectively analyzed. During the same period, 31 healthy controls, 26 rheumatoid arthritis (RA) patients and 27 ankylosing spondylitis (AS) patients were included in control groups. Mann-Whitney U test was used to compare the NLR values between DM, healthy control, RA and AS groups. Spearman rank correlation analysis was performed to explore the relationship of NLR with creatine kinase (CK), lactic dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficiency of NLR for DM, and the area under ROC curve was compared using Z test. Pairwise Wilcoxon signed rank test was carried out to compare the NLR, CK, AST, ALT and LDH of DM patients before and after treatment. Results The NLR values were significantly higher in the DM, RA and AS groups than that in the healthy control group (U=29.0, 156.0, and 194.0, all P<0.01). The NLR value was significantly higher in the DM group than those in the RA and AS groups (U=333.0 and 213.0, both P<0.01). Spearman rank correlation analysis showed that NLR was positively correlated with CK, LDH, AST, ALT, CRP and ESR in DM patients (rs0.540, 0.288, 0.440, 0.498, 0.304, and 0.311, all P<0.05). The areas under the ROC curve of NLR, LDH, CK, ALT and AST in the diagnosis of DM were 0.981, 0.954, 0.931, 0.913 and 0.867, respectively, and the best cut-off values were 2.824, 241.0 U/L, 101.0 U/L, 25.50 U/L and 30.00 U/L, respectively. The area under the ROC curve of NLR was significantly higher than those of ALT and AST (Z=2.05 and 2.67, P=0.040 and 0.008). There was no significant difference in the area under the ROC curve among the other laboratory indicators (P>0.05). The NLR, CK, AST, ALT and LDH of DM patients were significantly decreased after treatment versus before treatment (Z=3.28, 4.68, 4.62, 2.12, and 4.44, all P<0.05). Conclusion NLR can be used to evaluate the disease activity and severity of DM, and it is helpful for the clinical diagnosis and prediction of treatment response in DM. |
| Key words: neutrophil-lymphocyte ratio dermatomyositis disease activity creatine kinase |
