血小板/淋巴细胞比值与类风湿关节炎系统受累和疾病活动相关分析  

Correlation analysis of platelet-lymphocyte ratio with system involvement and disease activity in rheumatoid arthritis

作　　者：王子铭 周莹 李晓军 虞伟[2] WANG Zi-ming;ZHOU Ying;LI Xiao-jun;YU Wei(Department of Clinical Laboratory,Jinling Hospital,Nanjing University School of Medicine/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Department of Medical Laboratory,Taikang Xianlin Drum Tower Hospital Affiliated to Nanjing University Medical College,Nanjing 210046,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)中心实验科,南京210002 [2]南京大学医学院附属泰康仙林鼓楼医院医学检验科,南京210046

出　　处：《医学研究生学报》2020年第5期487-492,共6页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81071419);江苏省科技支撑计划-社会发展项目(BE2011786)。

摘　　要：目的监测病情活动及合并症对治疗类风湿关节炎(RA)至关重要。文中通过评估RA患者外周血血小板/淋巴细胞比值(PLR)水平,探讨其与RA患者系统受累情况、实验室指标和疾病活动的关系。方法回顾性分析2013年9月-2017年5月在东部战区总医院首诊为RA的患者123例,按照性别年龄1∶1分别匹配123例同期体检健康者(健康对照组)及其他自身免疫病患者(疾病对照组)123例。根据类风湿关节炎疾病活动指数(DAS28-CRP)将RA患者分为高活动度者和低活动度者,并分别对高、低活动度者以及健康对照组、疾病对照组PLR水平进行比较。评估RA患者系统受累情况与PLR水平关系;对PLR与DAS28-CRP及传统的炎症指标行Spearman相关性分析;通过受试者工作特征曲线(ROC)评价其在诊断RA及在区分RA病情活动程度中的应用效果。结果RA组患者外周血PLR[180.05(132.95,249.49)]显著高于健康对照组[133.63(103.17,140.99)]及疾病对照组[133.63(103.17,140.99)],差异均有统计学意义(P<0.01)。RA患者高活动度者PLR水平显著高于低活动度者[200.00(150.00,264.50)vs 137.00(116.50,183.25),P<0.01];RA合并循环系统受累[198.91(139.99,261.18)vs 146.26(117.61,185.71)]及感染性疾病患者PLR水平[219.28(176.54,468.17)vs 171.90(127.39,247.21)]均显著高于非合并患者(P<0.05)。RA患者类风湿因子(RF)阳性者PLR水平显著高于RF阴性者[189.77(147.18,252.20)vs 142.35(115.17,231.96),P<0.05];但抗环瓜氨酸肽抗体(A-CCP)阳性与阴性组间PLR水平差异无统计学意义[181.92(139.03,250.13)vs 149.16(114.94,248.66),P>0.05]。RA患者PLR与DAS28-CRP、C反应蛋白、血沉呈显著正相关(r分别为0.433、0.501、0.592,P<0.01)。PLR诊断RA和区分RA病情高度活动的AUC分别为0.68和0.73;当cut-off值分别为134.47和147.61时,敏感性分别为74.8%和77.5%,特异性分别为56.5%和63.2%。结论RA患者外周血PLR水平升高,并与疾病活动密切相关;且在合并循环系统受累、感Objective It is very important to monitor the disease activity and complications of patients in the treatment of rheumatoid arthritis(RA).In this paper,we evaluated the level of platelet-lymphocyte ratio(PLR)of peripheral blood in patients with rheumatoid arthritis and discussed the relationship between PLR and the system involvement,laboratory indexes,and disease activity in patients with rheumatoid arthritis.Methods From September 2013 to May 2017,123 patients with rheumatoid arthritis who were first diagnosed in the General Hospital of Eastern Theater Command were analyzed retrospectively.123 healthy persons(healthy control group)and 123 patients with other autoimmune diseases(disease control group)were matched according to the sex and age in a ratio of 1:1.According to the disease activity score 28 joints C-reactive protein(DAS28-CRP),RA patients were divided into the high activity group and the low activity group,and the PLR levels of high-activity and low-activity patients,healthy control group and disease control group were compared,respectively.To evaluate the relationship between system involvement and PLR level in RA patients;to analyze the correlation between PLR and DAS28-CRP and traditional inflammatory indexes by Spearman;to evaluate the application effect of receiver operating characteristic curve(ROC)in the diagnosis of RA and the differentiation of disease activity of RA patients.Results The PLR level of RA patients was significantly higher than that of healthy people[133.63(103.17,140.99)]and disease control group[159.83(104.22,203.55)],and the difference was statistically significant(P<0.01);the PLR level of RA patients in the high activity group was significantly higher than that in the low activity group[200.00(150.00,264.50)vs 137.00(116.50,183.25),P<0.01];the level of PLR in RA group with circulatory system involvement and infectious diseases were significantly higher than that in the none group[198.91(139.99,261.18)vs 146.26(117.61,185.71),P<0.01;219.28(176.54,468.17)vs 171.90(127.39,247.2

关 键 词：类风湿关节炎 血小板与淋巴细胞比值 疾病活动度 共病 

分 类 号：R593.22[医药卫生—内科学]