风湿

外周血中性粒细胞/淋巴细胞比有助于GPA的诊断和评估

作者:Abaza NM,et al. 翻译:北医三院姚中强 来源:中国风湿病公众论坛 日期:2018-02-06
导读

         外周血中性粒细胞/淋巴细胞比有助于肉芽肿性多动脉炎的诊断和评估

关键字:  GPA 

        摘要:目的:确定肉芽肿性多动脉炎(GPA)患者的中性粒细胞/淋巴细胞比(NLR),并研究其与疾病表现和活动性的相关性。

        方法:研究纳入了44名GPA患者和44名性别和年龄匹配的对照。采集完整病史,进行全面临床检查,重点行口腔、实验室和影像学检查。使用伯明翰血管炎活动性评分表 (BVAS)评估疾病活动性。

        结果:患者(21 男、 23 女) 平均年龄45.66±7.24 岁, 病程6.8±3.6 年,平均BVAS评分 50.1±14.3。所有患者胞浆型抗中性粒细胞胞浆抗体(c-ANCA)阳性,只有5名患者p-ANCA阳性。GPA患者的MLR(5.1±2.4)显著高于对照(1.5±0.8) (P<.0001)。10名伴有色素膜炎的患者NLR (6.5±1.9)显著高于不伴有色素膜炎者 (4.7±2.4) (P=0.03)。而突眼患者 (n=10)、有皮肤表现患者 (n=17) 或缺血性心脏病 (n=9)者 NLR显著低于无这些表现者 (P值分别为P=.0001、P=.017和P=.046)。 NLR 与患者的临床特点无显著相关性。NLR与疾病活动性负相关但无统计学差异 (r=-0.02, P=.93)。

        结论:NLR可能在GPA发病中有至关重要的作用,参与色素膜炎或突眼、皮肤表现和缺血性心脏病。NLR可能作为一个未来的对GPA诊断和评估有用的类似于c-ANCA阳性的指标,可能在组织特异性和临床特点中其作用。

        附原文:

        Object:To determine toneutrophil-to-lymphocyte ratio (NLR) in granulomatosis with polyangiitis (GPA)patients and to study its relation to disease manifestations and activity.METHODS:Thestudy included 44 GPA patients and 44 matched age and sex controls. Fullhistory taking, thorough clinical examination with more attention to ocularexamination, laboratory and radiological investigations were considered.Disease activity was assessed using the BirminghamVasculitisActivityScore (BVAS).RESULTS:Thepatients (21 males and 23 females) had a mean age of 45.66±7.24 years, diseaseduration 6.8±3.6 years and BVAS 50.1±14.3. All patients had a positivecytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) while only 5 had apositive p-ANCA. The NLR was significantly increased in the GPA patients(5.1±2.4) compared to the control (1.5±0.8) (P<.0001). Ten patients withuveitis had a significantly higher NLR (6.5±1.9) compared to those without(4.7±2.4) (0.03) while those with proptosis (n=10), cutaneous manifestations(n=17) or ischemic heart disease (n=9) had a significantly lower NLR than thosewithout (P=.0001, P=.017 and P=.046 respectively). The NLR did notsignificantly correlate with any of the patients' characteristics. The NLRinversely yet insignificantly correlated with the disease activity (r=-0.02,P=.93).CONCLUSION:TheNLR may have a significant role in the pathogenesis of GPA, the development ofuveitis or proptosis, cutaneous manifestations and ischemic heart disease. NLRmay serve as a future potential companion to c-ANCA positivity in diagnosingand evaluating GPA and may play a role in the tissue-specific and clinicalcharacteristics.

        引自:Abaza NM,El-Latif EMA,Gheita TA.Clinical Significance ofNeutrophil/lymphocyte Ratio in Patients With Granulomatosis With Polyangiitis.Reumatol Clin.2017 Dec 20. pii: S1699-258X(17)30277-2. doi:10.1016/j.reuma.2017.11.003. [Epub ahead of print]

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