中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值联合颈动脉超声造影对大动脉炎患者心脏损害的评估价值

    Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in conjunction with contrast-enhanced ultrasound for assessing inflammatory response and disease activity in cardiac involvement in Takayasu’s arteritis

    • 摘要:
      目的 评价中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)联合颈动脉超声造影对大动脉炎(TA)患者心脏损害的评估价值。
      方法 选取空军军医大学第二附属医院风湿免疫科2015年1月~2023年12月收治的大动脉炎患者为研究对象,按照是否发生心脏损害将其分为:心脏损害组(n=43)和无心脏损害组(n=43),收集患者实验室检查、影像学检查及治疗用药进行比较分析,采用Pearson相关系数评价NLR和PLR与Kerr评分、红细胞沉降率(ESR)、C反应蛋白(CRP)、颈总动脉内-中膜厚度(IMT)、颈动脉造影强度分级(CEUS)的关系,采用受试者工作特征(ROC)曲线确定大动脉炎患者心脏损害的界值。
      结果 心脏损害组的NLR和PLR均显著高于无心脏损害组(2.9 ± 1.0 vs. 2.1 ± 0.8,P<0.01;166 ± 79 vs. 117 ± 51,P<0.01)。心脏损害组IMT、CEUS均较TA无心脏损害组明显升高(2.6 ± 0.6 vs. 1.5 ± 0.4,P<0.01;2.6 ± 0.5 vs. 1.6 ± 0.6,P<0.01)。心脏损害组患者NLR水平与CRP呈正相关(r=0.42,P<0.01),PLR与CRP、CEUS(r=0.34,P<0.05;r=0.35,P<0.05)呈正相关。多因素Logistic回归分析结果显示,NLR、IMT、CEUS均为TA合并心脏损害的独立危险因素。NLR判断心脏损害的ROC曲线下面积为0.865,其截断点(cut off value)为2.265,灵敏度为69.8%,特异度为90.7%。PLR判断心脏损害的ROC曲线下面积为0.812,其截断点(cut off value)为111.275,灵敏度为76.7%,特异度为79.1%。
      结论 NLR和PLR联合颈动脉超声造影可用于对大动脉炎患者心脏损害的疾病评估。

       

      Abstract:
      AIM   To assess the utility of NLR, PLR, IMT and contrast-enhanced ultrasound (CEUS) as predictive markers for monitoring inflammatory responses and the disease activity in cardiac involvement in Takayasu’s arteritis.
      METHODS A cohort retrospective study encompassing 86 patients (43 with cardiac compromise and 43 without) was conducted. A comparative analysis of NLR, PLR, IMT, and CEUS between TA patients with and without cardiac compromise was undertaken.
      RESULTS The NLR and PLR of the heart damage group were significantly higher than those of the non heart damage group (2.9 ± 1.0 vs. 2.1 ± 0.8, P<0.01; 166 ± 79 vs. 117 ± 51, P<0.01). The IMT and CEUS of the heart damage group were significantly higher than those of the TA non heart damage group (2.6 ± 0.6 vs. 1.5 ± 0.4, P<0.01; 2.6 ± 0.5 vs. 1.6 ± 0.6, P<0.01). The NLR level of the heart damage group was positively correlated with CRP (r=0.42, P<0.01), and PLR was positively correlated with CRP and CEUS (r=0.34, P<0.05; r=0.35, P<0.05). The results of multiple logistic regression analysis showed that NLR, IMT, and CEUS were independent risk factors for TA and cardiac damage. The area under the ROC curve for NLR to determine cardiac damage is 0.865, with a cut-off value of 2.265, a sensitivity of 69.8%, and a specificity of 90.7%. The area under the ROC curve for determining cardiac damage using PLR is 0.812, with a cut-off value of 111.275, a sensitivity of 76.7%, and a specificity of 79.1%.
      CONCLUSION NLR and PLR, in conjunction with contrast-enhanced ultrasound, can be employed to assess inflammatory response and the disease activity in cardiac involvement in Takayasu’s arteritis.

       

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