生物标志物复合性指标在阿维A治疗红皮病型银屑病疗效和停药复发中的预测价值探讨  

Predictive value of NLR,PLR,CAR and SII on efficacy and relapse after drug withdrawal in erythrodermic psoriasis patients treated with Acitretin

作　　者：胡中柱 张萌 陈昶 Hu Zhongzhu;Zhang Meng;Chen Chang(Dermatology Department,Huanggang Central Hospital Affiliated to Yangtze University,Huanggang 438000,Hubei,China;Dermatology Department,Qichun People's Hospital,Qichun 435300,Hubei,China)

机构地区：[1]长江大学附属黄冈市中心医院皮肤性病科,湖北黄冈438000 [2]湖北省蕲春县人民医院皮肤科,湖北蕲春435300

出　　处：《中国医学前沿杂志（电子版）》2022年第2期34-39,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板和淋巴细胞比值(plate-let to lymphocyte ratio,PLR)、C反应蛋白和白蛋白比值(C-reactive protein to albumin ratio,CAR)及系统性免疫性炎症指数(systemic immune-inflammation index,SII)在阿维A治疗红皮病型银屑病(erythrodermic psoriasis,EP)疗效和停药复发中的预测价值。方法连续纳入2014年1月至2019年6月在长江大学附属黄冈市中心医院皮肤科应用阿维A治疗的EP患者作为治疗组,并纳入同期在本院进行体检的120例健康体检者作为健康对照组。于治疗前和治疗后评估银屑病皮损面积及严重度指数(psoriasis area and severity index,PASI)评分。收集研究对象性别、年龄、中性粒细胞计数(neu-trophils,N)、淋巴细胞计数(lymphocyte,L)、血小板计数(platelet,PLT)、C反应蛋白(C-reactive protein,CRP)和白蛋白(albumin),计算NLR、PLR、CAR和SII,SII=PLT×N/L。结果治疗后,NLR、PLR、CAR、SII与PASI评分相比治疗前均显著降低(P均<0.05)。对阿维A治疗无应答EP患者的NLR、PLR、CAR、SII均显著高于应答EP患者(P均<0.05),而PASI评分在两组间比较差异无统计学意义(P>0.05)。治疗前NLR、PLR、CAR和SII预测治疗后无应答的曲线下面积(area under the curve,AUC)及95%CI分别为0.774(95%CI:0.674~0.874,P<0.001)、0.523(95%CI:0.399~0.647,P=0.706)、0.647(95%CI:0.518~0.776,P=0.016)和0.865(95%CI:0.778~0.951,P<0.001)。停药后复发EP患者的NLR、PLR、CAR、SII均显著高于未复发组(P均<0.05),而PASI评分在两组间比较差异无统计学意义(P>0.05),治疗前NLR、PLR、CAR和SII预测停药复发的AUC分别为0.737(95%CI:0.597~0.877,P=0.009)、0.495(95%CI:0.328~0.654,P=0.223)、0.750(95%CI:0.605~0.895,P=0.006)和0.885(95%CI:0.783~0.986,P<0.001)。结论SII对阿维A治疗EP的疗效和停药复发具有一定的预测价值,预测效能优于NLR、PLR和CAR。Objective To explore the predictive value of the ratio of neutrophil to lymphocyte(NLR),platelet to lymphocyte ratio(PLR),C-reactive protein and albumin ratio(CAR)and systemic immune-inflammation index(SII)on the efficacy and relapse after drug withdrawal in erythrodermic psoriasis(EP)patients treated with Acitretin.Method The EP patients treated with Acitretin at the Department of Dermatology,Huanggang Central Hospital Affiliated to Yangtze University from January 2014 to June 2019 were continuously enrolled,and 120 healthy subjects who underwent physical examinations in this hospital during the same period were included as healthy control group.Psoriasis area and severity index(PASI)scores were evaluated before and after treatment.The gender,age,neutrophils(N),lymphocytes(L),platelets(PLT),C-reactive protein(CRP),and albumin of the subjects were collected.Calculate NLR,PLR,CAR and SII,SII=PLT×N/L.Result After treatment,the scores of NLR,PLR,CAR,SII and PASI were significantly lower than before treatment(all P<0.05).The NLR,PLR,CAR,and SII of EP patients who did not respond to Acitretin were significantly higher than those of the responders(all P<0.05),while no significant difference was shown in PASI score between the two groups(P>0.05).The area under the curve(AUC)and 95%confidence interval(CI)of NLR,PLR,CAR and SII predicting non-response were 0.774(95%CI:0.674-0.874,P<0.001),0.523(95%CI:0.399-0.647,P=0.706),0.647(95%CI:0.518-0.776,P=0.016)and 0.865(95%CI:0.778-0.951,P<0.001).The NLR,PLR,CAR and SII of EP patients who relapsed after drug withdrawal were significantly higher than those of the non-relapsed group(P<0.05),but no significant difference was seen in PASI score between the two groups(P>0.05).The AUC of NLR,PLR,CAR and SII for relapse prediction after drug withdrawal were 0.737(95%CI:0.597-0.877,P=0.009),0.495(95%CI:0.328-0.654,P=0.223),0.750(95%CI:0.605-0.895,P=0.006)and 0.885(95%CI:0.783-0.986,P<0.001).Conclusion SII has a certain predictive value for the efficacy and relapse after drug withdrawal

关 键 词：红皮病型银屑病 中性粒细胞和淋巴细胞比值 血小板和淋巴细胞比值 C反应蛋白和白蛋白比值 受试者工作操作特征曲线 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]