| 红细胞分布宽度和中性粒细胞/淋巴细胞比值评估原发性胆汁性胆管炎患者肝损伤临床价值研究* |
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| 引用本文： | 张岚,李妍,杨宁,荆晶,刘爱霞,黄雨欣,李伯安.红细胞分布宽度和中性粒细胞/淋巴细胞比值评估原发性胆汁性胆管炎患者肝损伤临床价值研究*[J].实用肝脏病杂志,2022,25(3):367-370. |
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| 作者姓名： | 张岚 李妍 杨宁 荆晶 刘爱霞 黄雨欣 李伯安 |
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| 作者单位： | 100039 北京市 解放军总医院第五医学中心检验科(张岚,李妍,杨宁,刘爱霞,黄雨欣,李伯安);空军军医大学西京医院检验科(荆晶) |
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| 基金项目： | *科技部重大专项(编号:2020ZX10001002) |
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| 摘 要： | 目的 探讨应用红细胞分布宽度(RDW)和中性粒细胞/淋巴细胞比值(NLR)评估原发性胆汁性胆管炎(PBC)患者肝损伤的临床价值。方法 2017年3月～2019年12月我院收治的PBC患者93例,其中Ⅰ/Ⅱ期(轻度组)63例,Ⅲ期(重度组)30例。使用血常规分析仪检测血液中性粒细胞和淋巴细胞绝对计数,计算NLR,采用激光电阻抗法检测RDW,应用多元Logistics回归分析影响肝损伤程度的因素,应用ROC曲线分析RDW和NLR评估肝损伤的价值。结果 重度组RDW和NLR显著大于轻度组【分别为(15.8±3.2)%对13.3±2.9)%和(2.1±0.4)对(1.5±0.3),P<0.05】;重度肝损伤组有饮酒史的比率(33.3%对7.9%)、血清GGT水平【(395.3±6.5)U/L对(189.2±6.1)U/L】 、血清ALP水平【(352.1±49.2)U/L对(281.0±46.9)U/L】、RDW≥14.8%的比率(70.0%对46.0%)和NLR≥1.8的比率(76.7%对41.3%)显著高于轻度肝损伤组(所有P<0.05);多因素分析显示,有饮酒史【OR(95%CI)为1.8(1.1～2.9)】、GGT≥293.1 U/L【OR(95%CI)为1.7(1.2～2.5)】、ALP≥327.6 U/L【OR(95%CI)为1.9(1.2～2.8)】、RDW≥14.8%【OR(95%CI)为1.9(1.2～2.8)】和NLR≥1.8【OR(95%CI)为1.7(1.3～2.2)】是严重肝损伤的独立危险因素;分别以RDW=14.8%和NLR=1.8为截断点,其联合诊断严重肝损伤的AUC为0.854,其灵敏度为86.7%,显著高于两指标中任一指标的评估,而特异性为71.4%,稍低于两指标的单一评判。结论 应用NLR评估PBC患者肝损伤程度具有一定的临床价值,其简单、易得,联合RDW可提高灵敏度,但特异性较差,两者联合应用的价值需要进一步探讨。
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| 关 键 词： | 原发性胆汁性胆管炎 红细胞分布宽度 中性粒细胞/淋巴细胞比值 肝损伤 评估 |
| 收稿时间： | 2021-11-18 |
Clinical application of blood red blood cell distribution width and neutrophil to lymphocyte ratio in evaluating liver damage in patients with primary biliary cholangitis |
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| Zhang Lan,Li Yan,Yang Ning,et al.Clinical application of blood red blood cell distribution width and neutrophil to lymphocyte ratio in evaluating liver damage in patients with primary biliary cholangitis[J].Journal of Clinical Hepatology,2022,25(3):367-370. |
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| Authors: | Zhang Lan Li Yan Yang Ning |
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| Affiliation: | Department of Clinical Laboratory, Fifth Medical Center, PLA General Hospital, Beijing 100039, China |
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| Abstract: | Objective The aim of this study was investigate the clinical application of blood red blood cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) in evaluating liver damage in patients with primary biliary cholangitis (PBC). Methods 93 PBC patients, including 30 with severe(stage Ⅲ) and 63 with mild (stage I /Ⅱ) liver injury, were enrolled in our hospital between March 2017 and December 2019. The RDW and NLR were obtained and calculated routinely. The univariate and multivariate Logistic regression analysis was performed to predict the risk factors for severe liver injuries, and the diagnostic efficacy of any parameter was evaluated by area under the receiver operating characteristic curve (AUC). Results The RDW and NLR in patients with severe liver injury were significantly higher than those in patients with mild liver injury (15.8±3.2)% vs. 13.3±2.9)%, and (2.1±0.4) vs. (1.5±0.3), respectively, P<0.05]; the percentages of alcohol hobby (33.3% vs. 7.9%), serum GGT level (395.3±6.5)U/L vs. (189.2±6.1)U/L], serum ALP level (352.1±49.2)U/L vs. (281.0±46.9)U/L], the RDW≥14.8%(70.0% vs. 46.0%) and the NLR≥1.8(76.7% vsl 41.3%)in patients with severe liver injury were significantly higher than in patients with mild liver injury (all P<0.05); the multivariate Logistic regression analysis showed that the alcohol intake OR(95%CI):1.8(1.1-2.9)], GGT≥293.1 U/LOR(95%CI):1.7(1.2-2.5)], ALP≥327.6 U/LOR(95%CI):1.9(1.2-2.8)], the RDW≥14.8%OR(95%CI):1.9(1.2-2.8)] and NLR≥1.8OR(95%CI):1.7(1.3-2.2)] were the independent risk factors for PBC patients with severe liver injury; the AUC was 0.854, with the sensitivity of 86.7% and the specificity of 71.4% when the RDW and NLR combination (RDW=14.8% and NLR=1.8 were set as the cut-off-value) was applied to predict severe liver injury in patients with PBC. Conclusion The NLR and RDW are promising index in predicting liver damage in patients with PBC, which is easily obtained, and needs further clinical investigation. |
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| Keywords: | Primary biliary cholangitis Red blood cell distribution width Neutrophil to lymphocyte ratio Liver damage Prediction |
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