61例视神经脊髓炎谱系疾病临床特点、NLR、ELR对疾病严重程度的影响

目的 探讨61例视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders, NMOSD)患者的临床特点、中性粒细胞淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、嗜酸性粒细胞淋巴细胞比值(eosinophil to lymphocyte ratio,ELR)对疾病严重程度的影响。方法 回顾性分析2017年6月至2021年6月于锦州医科大学附属第一医院神经内科首次确诊为NMOSD的61例患者并纳入NMOSD组。收集NMOSD患者的一般资料(性别、年龄)、伴随抗体,同时选取同期性别、年龄相匹配的61例健康体检者作为对照组,收集NMOSD组和健康对照组的免疫炎性指标胱抑素C(CysC)、尿酸(UA)、C-反应蛋白(CRP)、中性粒细胞、嗜酸性粒细胞、淋巴细胞、血小板],计算出NLR、ELR、MLR、PLR,并对NMOSD患者分别进行扩展残疾状态量表评分(expanded disability status scale,EDSS),根据量表结果进行分组;分别比较NMOSD组与对照组、NMOSD轻症组与中重症组的CysC、UA、CRP、NLR、ELR、MLR、PLR,采用二元Logistic回归分析、ROC曲线分析上述差异有统计学意义的指标与病情严重程度的相关性。结果 NMOSD组与健康对照组相比,CRP、NLR、ELR、MLR、PLR差异有统计学意义(P<0.05)。轻症NMOSD组与中重症NMOSD组相比,合并其他自身抗体、NLR、ELR差异有统计学意义(P<0.05)。二元Logistic回归分析,NLR(OR=4.082,95%CI=0.970-7.177,P=0.035)、ELR(OR=5.541,95%CI=0.001-8.225,P=0.045)、合并其他自身免疫抗体(OR=0.105,95%CI=0.002-4.997,P=0.038)是影响NMOSD患者疾病严重程度的独立危险因素(P<0.05)。NLR联合ELR为评价疾病严重程度最高效能指标,最佳临界值为0.299,曲线下面积为0.885,特异度为0.765,敏感度为0.926。结论 合并其他自身免疫抗体影响NMOSD患者的病情严重程度,NLR、ELR可作为评价NMOSD严重程度变化的有效指标。

Analysis of clinical characteristics of 61 cases of neuromyelitis optica spectrum disorders and the influence of NLR and ELR on disease severity

Objective To investigate the clinical characteristics, neutrophil to lymphocyte ratio and eosinophil to lymphocyte ratio of 61 patients with neuromyelitis optica spectrum disorders (NMOSD). Methods A total of 61 patients admitted to the Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University from June 2017 to June 2021 and diagnosed as acute stage of NMOSD were collected.NMOSD patients’ general clinical information(gender, age), concomitant antibodies were gathered.61 healthy volunteers with matched gender and age were randomly selected from physical examination department as healthy controls(HCs). Routine blood indexes of both groups (neutrophil, eosinophil, monocyte, lymphocyte, platelet, uric acid, cystatin C, C-reactive protein) were collected, and neutrophil to lymphocyte ratio(NLR), eosinophil to lymphocyte ratio(ELR), monocyte to lymphocyte ratio(MLR), platelet to lymphocyte ratio(PLR) were calculated separately according to the above laboratory indicators.The extended disability scale(EDSS) on admission and groups were divided according to the scale results. Cys C, UA, CRP, NLR, ELR, MLR, PLR of NMOSD group and control group, mild- and moderate- severe NMOSD groups were compared.Binary Logistic regression analysis and ROC curve were used analyze the correlation between the above indicators with statistically significant differences and the severity. Results Compared with 61 healthy controls, gender, CRP, NLR, ELR, MLR and PLR of 61 NMOSD patients were statistically significant(P<0.05). In univariate analysis, there were statistically significant differences in the combination of other autoantibodies, NLR and ELR between the mild NMOSD group and moderate severe group(P<0.05). Binary Logistic regression analysis showed, NLR(OR=4.082,95%CI=0.970-7.177,P=0.035), ELR(OR=5.541,95%CI=0.001-8.225,P=0.045), combined with other autoimmune antibodies(OR=0.105,95%CI=0.002-4.997,P=0.038) were independent risk factors affecting the severity in NMOSD patients(P<0.05). NLR combined ELR was the most effective index for evaluating the severity of disease, and the optimal critical value of NLR combined ELR was 0.299, the area under the curve was 0.885, the specificity was 0.765, and the sensitivity was 0.926. Conclusion Patients with other autoimmune antibodies has a significantly high impact on the severity of the disease, and the prognosis is worse.NLR, ELR were effective indicator to evaluate changes in disease severity.