血液细胞比率在皮肌炎及其合并症中的诊断和预测价值  

The Diagnostic and Predictive Value of Blood Cell Ratio in Dermatomyositis and Its Comorbidities

作　　者：南京柱 张旭[2] 魏雪梅[2] 张帅 袁慧 NAN Jingzhu;ZHANG Xu;WEI Xuemei;ZHANG Shuai;YUAN Hui(Department of Clinical Laboratory,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Clinical Laboratory,the 1st Medical Center,Chinese PLA General Hospital,Beijing 10853,China)

机构地区：[1]首都医科大学附属北京安贞医院检验科,北京100029 [2]解放军总医院第一医学中心检验科,北京100853

出　　处：《标记免疫分析与临床》2024年第1期8-15,共8页Labeled Immunoassays and Clinical Medicine

基　　金：国家重点研发计划项目(编号:2022YFC2009600,2022YFC2009602)。

摘　　要：目的 探讨皮肌炎(DM)患者合并不同并发症时外周血血液细胞比率的诊断和预测价值.方法 收集在解放军总医院第一医学中心风湿病科住院治疗的皮肌炎患者183例(疾病组)和同时期健康体检者149例(对照组)血液细胞检测结果和临床数据进行统计学分析.比较DM患者与对照组的血液细胞及其比率的差异,采用ROC曲线与Logistic回归方法来评价和分析血液细胞比率在DM及其并发症的诊断效能和危险因素.结果 DM患者单核细胞与淋巴细胞比率(MLR)、中性粒细胞与淋巴细胞比率(NLR)和血小板与淋巴细胞比率(PLR)均显著高于对照组(P<0.001);女性DM患者合并间质性肺疾病(ILD)和心肌受累(MI)的患病率显著高于男性患者(P<0.001).血液细胞比率诊断DM的ROC曲线下面积AUC分别为0.868(MLR)、0.910(NLR)和0.784(PLR).DM患者合并ILD时MLR显著高于无ILD患者(P=0.024);而DM患者合并MI时NLR显著高于无MI患者(P=0.023).PLR在DM合并ILD和MI时差异均无统计学意义(P>0.05).MLR鉴别诊断ILD的ROC曲线下面积AUC为0.598(P=0.024,95%CI0.515~0.682);NLR鉴别诊断MI的ROC曲线下面积AUC为0.631(P=0.023,95%CI0.522~0.740).单因素和多因素回归分析结果显示,MLR为影响DM患者合并ILD的独立危险因素(P=0.003,OR=9.400,95%CI2.120~41.678);而NLR和年龄是影响DM患者合并MI的危险因素(NLR的OR=1.036,95%CI1.008~1.064,P=0.012;年龄的OR值:1.104,95%CI1.003~1.215,P=0.043).结论 血液细胞比率是DM患者简单方便、经济、准确的诊断和预测标志物.MLR和NLR分别是DM患者合并ILD和合并MI的独立危险因素,并对DM的诊断具有一定的预测价值.Objective To evaluate the value of peripheral blood cell ratio as a clinical stage of dermatomyositis(DM),and to explore the diagnostic and predictive value of blood cell ratio in DM patients with different complications.Methods The blood cell test results and clinical data of 183 patients with dermatomyositis(disease group)and 149 healthy subjects(control group)hospitalized in the Rheumatology Department of the 1st Medical Center of PLA General Hospital were collected for the statistical analysis.Blood cell ratio between DM patients and control group was compared.ROC curve and logistic regression method were used to evaluate the diagnostic efficiency and risk factors of blood cell ratio in DM and its complications.Results The ratio of monocyte to lymphocyte(MLR),neutrophil to lymphocyte(NLR)and platelet-to-lymphocyte(PLR)in DM patients were significantly higher than those in the control group(P<0.001).The prevalence of interstitial lung disease(ILD)and myocardial involvement(MI)in female DM patients was significantly higher than that in male DM patients(P<0.001).AUCs for blood cell ratio diagnosis of DM were 0.868(MLR),0.910(NLR)and 0.784(PLR),respectively.MLR of DM patients with ILD was significantly higher than that of DM patients without ILD(P=0.024).NLR of DM patients with MI was significantly higher than that of patients without MI(P=0.023).There was no significant difference in PLR among DM patients with ILD and MI(P>0.05).AUC for MLR differential diagnosis of ILD was 0.598(P=0.024,95%CI 0.515-0.682);AUC for NLR differential diagnosis MI was 0.631(P=0.023,95%CI 0.522-0.740).Univariate and multivariate regression analysis showed that MLR was an independent risk factor for ILD in DM patients(P=0.003,OR=9.400,95%CI 2.120-41.678).NLR and age were risk factors for MI in DM patients(NLR OR=1.036,95%CI=1.008-1.064,P=0.012;Age OR=1.104,95%CI 1.003-1.215,P=0.043).Conclusion Blood cell ratio is a simple,convenient,economical and accurate diagnostic and predictive marker for DM patients.MLR and NLR are independent ri

关 键 词：皮肌炎 单核细胞与淋巴细胞比率 中性粒细胞与淋巴细胞比率 血小板与淋巴细胞比率 间质性肺疾病 心肌受累 

分 类 号：R593.26[医药卫生—内科学]