姚芳兰,樊丹丹,屈慧,苗常青,米琛,高烨
YAO Fanglan,FAN DANDan,QU Hui,MIAO Changqing,MI Chen,GAO Ye

• 1:西安交通大学第一附属医院急诊科
• 2:西安交通大学第一附属医院消化内科

摘要(Abstract)：

目的:探讨中性粒细胞与淋巴细胞比值(NLR)对克罗恩病(CD)活动度及炎症严重度的预测价值。方法:采用简化CD活动指数(CDAI)对69例(112例次) CD患者进行疾病活动度的评分,根据CDAI评分分为活动组(> 5分,n=67)及缓解组(≤4分,n=45);比较2组患者年龄、性别、中性粒细胞计数、单核细胞计数、血小板计数(PLT)、淋巴细胞计数、平均血小板体积(MPV)、NLR、单核细胞计数/淋巴细胞计数比值(MLR)、PLT/淋巴细胞计数比值(PLR),采用二元Logistic回归分析预测CD活动的独立危险因素,采用受试者工作特征(ROC)曲线下面积(AUC)分析NLR对CD活动期的预测价值;以复发、死亡或试验结束(最长6年)作为随访事件的终点,采用采用Kaplan-Meier(K-M)生存曲线评价NLR对CD疾病复发情况的预测价值;再将活动组患者根据病情严重程度分为轻度活动组(n=20)、中度活动组(n=35)、重度活动组(n=12),比较3组上述指标的差异,采用多元有序Logistic回归分析预测CD活动期严重度的独立危险因素。结果:活动组NLR高于缓解组,差异有统计学有意义(P=0. 032);二元Logistic回归分析结果显示NLR为预测CD活动度的独立危险因素,NLR预测CD活动期的AUC为0. 787,NLR截断值为3. 76,灵敏度、特异度分别为56. 72%、91. 11%,95%可信区间为0. 704～0. 871; K-M生存分析结果显示,长期随访中,NLR在活动组和缓解组比较差异无统计学意义(P>0. 05);单核细胞计数、淋巴细胞计数、中性粒细胞计数及NLR在活动期的轻、中、重度组间比较,差异有统计学意义(P <0. 05),二元Logistic回归分析结果显示,NLR是CD活动期严重度的独立危险因素。结论:NLR能作为预测CD活动性和严重程度的指标,NLR值> 3. 76提示CD处于活动期。
Objective: To investigate the predictive value of neutrophil to lymphocyte ratio( NLR for Crohn's disease( CD) activity and inflammatory severity. Methods: The reduced CD activity index( CDAI) was adopted to score the disease activity of 69( 112) patients with CD,the group was divided into active group( > 5 points,n = 67) and the remission group( ≤4 points,n = 45) according to the CDAI score. Following values of both groups were compared: age, gender, neutrophil count,monocyte count,platelet count( PLT),lymphocyte count,mean platelet volume( MPV),NLR,monocyte count/lymphocyte count ratio( MLR),PLT/lymphocyte count ratio( PLR); binary Logistic regression analysis was adopted to predict independent risk factors for CD activity,the area under the Receiver Operating Characteristic( ROC) curve( AUC) was used to analyze the predictive value of NLR to CD activity. Recurrence,death,or the end of the experiment( up to 6 years) would mark the endpoints of the follow-up event,and Kaplan-Meier( K-M) survival curve was used to evaluate the predictive value of NLR for CD disease recurrence. According to the severity of the disease,patients in the active group were divided into mildly active group( n = 20),moderately active group( n = 35) and severely active group( n = 12); the differences of the above indicators of 3 groups were compared,multivariate ordered Logistic regression analysis was used to predict independent risk factors for CD activity severity. Results: The NLR of the active group was higher than that of remission group,difference was statistically significant( P = 0. 032),binary Logistic regression analysis showed that NLR was an independent risk factor for predicting CD activity. The NLR predicted the CD activity period with an AUC of 0. 787,a truncated NLR value of 3. 76,a sensitivity value of 56. 72%,a specificity value of 91. 11%,and a 95% confidence interval of 0. 704 ～ 0. 871. K-M survival analysis showed that there was no statistically significant difference in NLR between the active group and the remission group during long-term follow-up( P > 0. 05). Mononuclear cell count,lymphocyte count,neutrophil count,and NLR were significantly different among the mild,moderate,and severe groups( P < 0. 05). Binary Logistic regression analysis showed that NLR was an independent risk factor for CD activity severity. Conclusion: NLR can be used as a predictor of CD activity and severity,NLR value > 3. 76 indicates that the CD is active.

关键词(KeyWords)： 复发;回归分析;克罗恩病;中性粒细胞与淋巴细胞比值;活动度;严重度
recurrence;regression analysis;crohn's disease(CD);neutrophil to lymphocyte ratio(NLR);activity;severity

Abstract:

Keywords:

基金项目(Foundation): 陕西省社会发展科技攻关项目(2016SF-117)

作者(Author): 姚芳兰,樊丹丹,屈慧,苗常青,米琛,高烨
YAO Fanglan,FAN DANDan,QU Hui,MIAO Changqing,MI Chen,GAO Ye

DOI: 10.19367/j.cnki.2096-8388.2020.12.016

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