类风湿关节炎患者骨密度与中性粒细胞计数与淋巴细胞计数的比值相关性研究  

Correlation between bone mineral density and neutrophil/lymphocyte ratio in patients with rheumatoid arthritis

作　　者：张丽[1] 侯韬[1] 赵建治[2] 周建尧[1] Zhang Li;Hou Tao;Zhao Jianzhi;Zhou Jianyao(Department of Rheumatology,Shaoxing Hospital,China Medical University,Shaoxing 312000,China;Department of Hematology,Shaoxing Hospital,China Medical University,Shaoxing 312000,China)

机构地区：[1]中国医科大学绍兴医院风湿免疫科,绍兴312000 [2]中国医科大学绍兴医院血液内科,绍兴312000

出　　处：《中华风湿病学杂志》2022年第7期461-465,I0003,共6页Chinese Journal of Rheumatology

摘　　要：目的:研究中性粒细胞计数与淋巴细胞计数的比值(NLR)与RA骨密度的关系,评价其对RA伴骨质疏松的诊断价值。方法:筛选134例RA患者及69名健康体检者,比较2组NLR水平间的差异。应用双能X线吸收法(DXA)对病例组腰椎1~4和股骨颈骨密度进行检测,并将病例组分为骨量正常组(44例)、骨量减少组(47例)以及骨质疏松症组(43例),记录其身高、体质量、病程、血小板平均体积数、ESR、CRP、补体C3、补体C4、RF、抗CCP抗体、骨密度等相关指标,采用单因素方差分析、Kruskal-Wallis检验或者χ^(2)检验比较3组间的NLR、BMI、性别、年龄等指标的差异,通过相关性分析检测NLR、骨量与各指标的相关性,采用有序多分类Logistic回归分析评价各指标对骨质疏松的影响,并通过受试者工作特征曲线(ROC曲线)预测NLR及联合相关指标对骨质疏松的诊断价值。结果:RA患者NLR(3.1±1.7)高于健康对照组(1.7±0.5)(t=21.27,P<0.001),在骨质疏松组、骨量减少组、骨量正常组中,年龄[(66±8)岁、(62±10)岁、(50±13)岁]、病程[(15±10)年、(9±8)年、(7±7)年]、BMI[(20±4)kg/m^(2)、(22±3)kg/m^(2)、(24±3)kg/m^(2)]、NLR[(3.9±2.3)、(2.7±1.2)、(2.6±1.0)]、CRP[(41±43)mg/L、(28±34 mg/L、(18±26)mg/L]、ESR[(46±30)mm/1 h、(36±26)mm/1 h、(26±20)mm/1 h]在3组间差异均有统计学意义(χ^(2)=32.92,P<0.001;H=17.41,P<0.001;F=12.04,P<0.001;H=11.62,P=0.030;H=13.78,P=0.001;F=7.18,P=0.001)。相关性分析提示NLR与CRP、ESR、抗CCP抗体、股骨颈骨密度、DAS28评分、年龄相关,其r分别为0.49(P<0.001),0.39(P<0.001),0.30(P<0.001),-0.18(P=0.042),0.50(P<0.001),0.17(P=0.046);股骨颈与年龄、BMI、病程、CRP、ESR相关,其r分别为-0.46(P<0.001),0.38(P<0.001),-0.39(P<0.001),-0.34(P<0.001),-0.28(P=0.001),腰椎1~4与年龄、BMI、CRP、ESR的r分别为-3.41(P<0.001),0.39(P<0.001),-0.22(P=0.010),-2.42(P=0.005),骨密度与DAS28、抗CCP抗体无相关性。有序多分类Logistic回归分析�Objective To investigate the relationship between neutrophil/lymphocyte ratio(NLR)and bone mineral density(BMD)in rheumatoid arthritis(RA),and to evaluate its diagnostic value in RA with osteoporosis.Methods 134 RA patients and 69 healthy subjects were screened and NLR levels were compared between the two groups.Bone mineral density of lumbar L1-4 and femoral neck was measured by dual energy X-ray absorption(DXA),and the patients were divided into normal bone mass group(44 cases),reduced bone mass group(47 cases)and osteoporosis group(43 cases).Height,weight,course of disease,mean platelet volume,erythrocyte sedimentation rate(ESR),C-reactionprotein(CRP),complement C3,complement C4,rheumatoid factor(RF),anti-cyclic citrullinated peptide(anti-CCP)antibody,bone mineral density and other related indicators were recorded.The differences of NLR,body mass index(BMI)gender,age and other indicators among the three groups were compared by One-way Analysis of Variance(ANOVA)and Kruskal-Wallis test,orχ^(2)test.Correlation analysis was conducted to detect the correlation between NLR,bone mass and each indicator,and ordered multi-classification Logistic regression analysis was used to evaluate the im-pact of each indicator on osteoporosis,and receiver operating characteristic curve(ROC)was used to predict the diagnostic value of NLR and combined related indicators on osteoporosis.Results NLR of RA patients(3.1±1.7)was higher than that of healthy controls(1.7±0.5)(F=21.27,P<0.001).In the osteoporosis group,the reduced bone mass group,and the normal bone mass group,age(66±8),(62±10),(50±13),disease course(15±10),(9±8,(7±7),BMI(20±4)kg/m^(2),(22±3)kg/m^(2),(24±3)kg/m^(2),NLR(3.9±2.3,2.7±1.2,2.6±1.0),CRP(41±43)mg/L,(28±34)mg/L,(18±26)mg/L,ESR(46±30)mm/1 h,(36±26)mm/1 h,(26±20)mm/1 h were significantly different among the three groups(χ^(2)=32.92,P<0.001;H=17.41,P<0.001;F=12.04,P<0.001;H=11.62,P=0.030;H=13.78,P=0.001;F=7.18,P=0.001).Correlation analysis showed that NLR was correlated with CRP,ESR,anti-CCP ant

关 键 词：关节炎 类风湿 骨密度 中性粒细胞计数与淋巴细胞计数比值 

分 类 号：R593.22[医药卫生—内科学]