多发性骨髓瘤患者首次治疗部分缓解时NLR、MLR与预后的关系

目的 探讨多发性骨髓瘤（MM）患者首次治疗部分缓解时中性粒细胞/淋巴细胞比值（NLR）、单核细胞/淋巴细胞比值（MLR）与预后的关系。方法 经治疗后首次部分缓解的MM患者106例,随访观察患者生存情况,计算无进展生存期（PFS）和总生存期（OS）。采用受试者工作特征（ROC）曲线分析首次部分缓解时NLR和MLR预测患者预后的效能并获取最佳截断值,将患者分为高NLR组、低NLR组和高MLR组、低MLR组,分别比较高NLR组与低NLR组、高MLR组与低MLR组患者的PFS和OS。收集首次部分缓解时患者的年龄、性别、血红蛋白、白/球蛋白比值、乳酸脱氢酶、β2-微球蛋白、血清钙、胱抑素C、轻链类型、NLR、MLR资料,纳入Cox回归分析模型,分析MM患者PFS、OS的影响因素。结果 106例患者随访至2022年10月,死亡27例,总生存率为74.5%。患者中,高NLR组（NLR>2.14） 49例、低NLR组（NLR≤2.14） 57例和高MLR组（MLR>0.36） 46例、低MLR组（MLR≤0.36） 60例。低NLR组尿酸<283.5μmol/L者比例高于高NLR组,...     

炎症标志物对早期小肝癌行射频消融术预后的预测价值

目的 探讨中性粒细胞/淋巴细胞比值（NLR）、红细胞分布宽度/淋巴细胞比值（RLR）及淋巴细胞/单核细胞比值（LMR）在早期小肝癌射频消融术后的预后价值。方法 选取2011年9月—2020年12月在天津市第二人民医院行射频消融术的132例初诊早期肝细胞癌（HCC）患者。收集患者术前资料并随访观察复发和生存情况。运用X-tile工具以5年生存率及无复发生存率确定NLR、RLR和LMR的最佳截断值并组合成为N-R-L评分,并据此分为N-R-L 0分组（n=92）、N-R-L 1分组（n=29）和N-R-L 2分组（n=11）。计数资料3组间比较采用χ²检验。采用Kaplan-Meier方法绘制生存曲线,并用log-rank检验对无复发生存率及总体生存率进行组间比较。单因素分析采用log-rank检验,并将log-rank检验分析中具有统计学意义的因素纳入多因素Cox回归分析以确定无复发生存率与总生存率的危险因素。结果 N-R-L 0分、N-R-L 1分和N-R-L 2分组的组间Child-Pugh分级、Alb比较差异均有统计学意义（χ²值分别为1...     

血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值对肝细胞癌射频消融术后长期存活患者的预后评估价值

目的探讨血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)对射频消融术后生存期超过5年的肝细胞癌(HCC)患者预后评估价值。方法选取2006年6月-2012年2月于首都医科大学附属北京佑安医院行经肝动脉化疗栓塞术联合射频消融治疗且生存期超过5年的肝细胞癌患者135例。收集所有患者基线实验室及影像检查资料,根据血常规结果计算NLR与PLR。计数资料组间比较采用χ~2检验。采用受试者工作特征曲线(ROC曲线)确定NLR、PLR临界值,Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率,将log-rank检验分析中具有统计学差异的指标纳入Cox多因素分析。结果根据ROC曲线,确定NLR临界值为2. 08,PLR临界值为96. 82。按照治疗前NLR、PLR临界值分为:低NLR组(NLR 2. 08,n=60)与高NLR组(NLR≥2. 08,n=75),低PLR组(PLR 96. 82,n=78)与高PLR组(PLR≥96. 82,n=57),结果显示低NLR组与高NLR组患者AFP、巴塞罗那分期差异均有统计学意义(χ~2值分别为15. 125、9. 649,P值均0. 05);低PLR组与高PLR组患者AFP、ChE、巴塞罗那分期、肿瘤大小差异均有统计学意义(χ~2值分别为25. 511、4. 220、9. 265、16. 403,P 0. 05)。低NLR组、低PLR组患者生存率分别高于高NLR组、高PLR组(χ~2值分别为31. 302、92. 905,P值均0. 01)。Cox多因素分析显示,术前PLR[比值比(OR)=9. 634,95%可信区间(95%CI):5. 167～17. 964,P 0. 001]、ChE(OR=0. 404,95%CI:0. 236～0. 692,P=0. 001)、肿瘤大小(OR=3. 861,95%CI:1. 760～8. 472,P=0. 001)、巴塞罗那分期(OR=9. 607,95%CI:1. 228～75. 151,P=0. 031)是HCC射频消融术后患者长期存活(生存期超过5年)生存率的独立影响因素。结论 PLR是影响HCC射频消融术后长期存活患者生存率的独立危险因素,随着PLR升高,患者预后越差,可结合肿瘤相关情况作为评价HCC射频消融术后长期存活的重要预后指标。     

术前血清学炎症指标对急性心肌梗死患者PCI术后生存时间的评价及炎症标志物构建

目的 探究术前血清学炎症指标对急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后生存时间的评价及炎症标志物构建。方法 回顾性选取208例经PCI治疗的AMI患者,收集并分析术前临床资料和实验室检查结果,根据受试者工作特征(ROC)曲线分析中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)评估PCI术后生存时间的最佳截断值来构建预测AMI患者PCI术后生存时间的系统炎症标志物评分(SIMS);绘制Kaplan-Meier生存曲线比较不同评价指标患者的全因病死率,采用单因素与多因素Cox风险回归分析影响AMI患者预后的危险因素。结果 患者均得到有效随访1～48个月,平均(45.39±8.74)个月,全因死亡19例(9.1%)。ROC曲线分析结果显示,PLR和NLR评估AMI术后死亡风险的曲线下面积(AUC)为0.883和0.765,最佳截断值分别为155.93和3.55。Kaplan-Meier生存曲线分析结果显示,PLR>155.93组、NLR>3.55组AMI患者PCI术后的死亡率显著高于PLR≤155.93组、NLR≤3.55组(χ²     

血NLR、PLR和LMR检测对老年肺癌的诊断效能研究

目的 探索老年肺癌患者的血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)单独检测及联合检测对肺癌的诊断效能。方法 收集2021年1月1日—2022年12月31日于梅州市人民医院的患者的临床资料，筛选出首次诊断为肺癌患者232例(设为肺癌组),选择同期年龄匹配的健康体检者232例(设为健康对照组)。对2组临床资料进行回顾性分析与比较。结果 肺癌组血NLR、 PLR、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)水平高于健康对照组，而LMR水平低于健康对照组，差异均有统计学意义(P<0.05)。肺癌组NLR>3.0占比36.21%、 PLR≥200占比27.59%, LMR<3占比41.81%, CEA>5.0占比32.76%, CYFRA21-1≥3.3占比25.86%,均高于健康对照组的6.47%、 6.90%、 5.60%、 11.21%、 10.34%,差异均有统计学意义(P<0.05)。肺癌组中Ⅱ期、Ⅲ期和Ⅳ期患者NLR、 PLR水平均高于Ⅰ期患者，而Ⅱ期和Ⅳ期患者LMR水平低于Ⅰ期...     

NLR、PLR及LDL-C/HDL-C与急性冠脉综合症在院主要不良心脏事件的关联

【摘要】 目的 研究中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及低密度脂蛋白与高密度脂蛋白比值（LDL-C/HDL-C）与急性冠脉综合症（ACS）在院主要不良心脏事件的关系，探讨NLR、PLR、LDL-C/HDL-C对ACS患者在院主要不良心脏事件发生的预测作用。方法 将340例患者依据临床症状、辅助检查及冠脉造影分为正常对照组及ACS组，ACS组以临床诊断及预后分为UA组、NSTEMI组、STEMI组、MACEs组；ACS组又以NLR=5.44分为高NLR组、低NLR组，以PLR=129.70分为高PLR组、低PLR组，以LDL-C/HDL-C=2.75分为高LDL-CL/HDL-C组、低LDL-C/HDL-C组。检测外周血白细胞分类计数、血生化并计算NLR、PLR和LDL-C/HDL-C，应用SPSS 22.0软件进行统计分析。结果 （1）NLR在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组中依次升高，且两组指标比较差异有统计学意义（P<0.05）；PLR值在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组依次升高，且MACEs组、STEMI组与正常对照组及UA组差异具有统计学意义（P<0.05）；ACS患者LDL-C/HDL-C值高于正常对照组LDL-C/HDL-C值，且两组之间差异有统计学意义(P<0.05)。（2）高NLR组患者在院主要不良心脏事件发生率明显高于低NLR组，两组间差异有统计学意义（P<0.05）；高PLR组患者在院主要不良心脏事件发生率高于低PLR组，两组间差异有统计学意义（P<0.05）。（3）多因素Logistic回归分析显示年龄、高血压、NLR、LDL-C/HDL-C均是ACS的独立危险因素。结论 NLR、LDL-C/HDL-C是ACS的独立危险因素，NLR、PLR对ACS患者在院发生主要不良心脏事件有预测作用。     

中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值与大动脉炎疾病活动性的关联性及其应用价值

目的 评估大动脉炎患者的中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）水平及其与疾病活动的关联性及其应用价值。 方法 纳入空军军医大学第二附属医院风湿免疫科2013年1月至2019年12月的住院和门诊随访病例55例（大动脉炎组）,对其实验室检查、影像学检查及治疗方法进行分析。选取同时期体检的健康者56例（健康对照组）。对两组间的临床资料进行比较,采用Spearman相关系数评价NLR和PLR与Kerr评分、红细胞沉降率（ESR）和C反应蛋白（CRP）的关系,采用受试者工作特征（ROC）曲线确定大动脉炎疾病活动的界值。 结果 大动脉炎组的NLR和PLR均显著高于健康对照组(2.58 ± 0.15 vs.1.87 ± 0.11,P<0.01;175 ±11 vs.119±4,P<0.01)。NLR与CRP(r = 0.36,P<0.05)和ESR(r = 0.37,P<0.05)呈正相关,与Kerr评分呈负相关(r = ?0.31,P<0.05）。PLR与CRP(r = 0.65,P<0.01)和ESR(r = 0.76,P<0.01)呈正相关。PLR判断大动脉炎的最佳界值为163（灵敏度95%;特异度45%）,ROC曲线下面积为0.706。NLR判断大动脉炎的最佳界值为1.88（灵敏度68%;特异度78%）,ROC曲线下面积为0.726。 结论 NLR和PLR可用于判断大动脉炎患者的疾病活动性。     

中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对急性心肌梗死的意义

目的 探究中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）对急性心肌梗死（AMI进展及预后的意义。方法 回顾性分析我院2019年1月至2020年12月收治的86例AMI患者,入院当天检测中性粒细胞、淋巴细胞、血小板,并计算NLR与PLR。患者经过PCI预后一年内随访,根据发生预后不良事件（MACCE）情况,将患者分为对照组66例,MACCE组20例。Spearman相关系数分析NLR与PLR与AMI病情严重程度的相关性。ROC曲线分析NLR、PLR对预后MACCE的预测价值。Logitic回归分析MACCE发生的危险因素。结果 MACCE组NLR、PLR与Gebsini评分均高于对照组（P<0.05）。NLR、PLR与Gebsini评分呈正相关（P<0.05）。NLR、PLR水平ROC曲线下面积为0.753、0.815(P<0.05)。Logitic回归提示较高NLR、PLR是患者出现MACCE的独立危险因素（P<0.05）。结论 NLR、PLR与AMI患者疾病严重程度有关,且检测NLR、PLR对预后效果有较好的预测价值。     

CRP、NLR及PLR联合检测用于老年RA疾病活动度及对患者预后的评估价值

目的 分析C反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR)联合检测用于老年类风湿关节炎(RA)疾病活动度及对患者预后的评估价值。方法 选取84例老年RA患者为RA组,另取同期65例健康体检者为对照组。测定两组血浆中CRP、NLR及PLR水平,并绘制受试者工作特征(ROC)曲线分析各指标单独检测与联合检测的诊断价值;根据28个关节疾病活动度(DAS28)评分将RA患者分为轻、中、重度活动组,探讨CRP、NLR及PLR水平与DAS的关系;分析CRP、NLR及PLR水平与预后的关系。结果 RA组CRP、NLR及PLR水平显著高于对照组(P<0.001);ROC曲线显示,CRP、NLR及PLR诊断RA的曲线下面积(AUC)显著低于三者联合诊断RA的AUC(P<0.05);轻、中、重度活动组CRP、NLR及PLR水平依次显著升高(P<0.001);随着患者疗效提升,CRP、NLR及PLR水平依次显著降低(P<0.001)。结论 CRP、NLR及PLR水平与RA发生有关,均可用于RA的早期诊断,且三者联合诊断价值更高;且三者可用于RA...     

中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与溃疡性结肠炎内镜活动度相关性

[目的]研究中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio, NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio, PLR)与溃疡性结肠炎(ulcerative colitis, UC)患者Mayo内镜下评分(Mayo endoscopic score, MES)的相关性。比较NLR、PLR、C-反应蛋白(C-reactive protein, CRP)独立及联合评价内镜活动度的效能。[方法]收集2016-01-2019-06期间于武汉大学中南医院消化内科住院治疗的UC患者205例(内镜活动期UC 150例,内镜缓解期UC 55例)和年龄、性别匹配的健康对照者205例。收集纳入对象的一般临床信息及NLR、PLR、CRP及结肠镜MES等结果。[结果]UC组患者NLR、PLR明显高于健康对照组,内镜活动期UC患者NLR、PLR高于内镜缓解期患者;NLR、PLR均与MES、CRP、WBC呈正相关;NLR、PLR区分内镜活动期UC与内镜缓解期UC的最佳临界值分别为2.05(灵敏度77.3%、特异度60%)、184.77(灵敏度35.3%、特异度90.9%);虽然NLR、PLR独立预测UC内镜活动度的预测效能不如CRP,但是NLR、PLR联合CRP后预测效能较NLR、PLR独立预测时均有提高。而且CRP+NLR、CRP+NIR+PLR预测效能高于CRP独立预测效能,CRP+NLR预测内镜活动度的效能最高。[结论]NLR、PLR均可区分内镜活动期UC与内镜缓解期UC,且与MES、CRP、WBC呈正相关,NLR预测效能优于PLR。NLR、PLR独立预测UC内镜活动效能不如CRP,CRP联合预测效能较独立预测时均有提高,NLR联合CRP预测内镜活动度的效能最高。     

手术后中性粒细胞/淋巴细胞比例及血小板/淋巴细胞比例与非小细胞肺癌患者预后的相关性

目的 关注中性粒细胞/淋巴细胞比例(Neutrophil-to-Lymphocyte Ratio,NLR)及血小板/淋巴细胞比例(Platelet-to-Lymphocyte Ratio,PLR)与接受手术并行化疗的Ⅰb-Ⅲa期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者生存时间...     

Pre‐treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma

To determine whether pre‐treatment neutrophil/lymphocyte (NLR) or platelet/lymphocyte ratios (PLR) are predictive for progression in early‐stage classical Hodgkin lymphoma (cHL), we derived NLR and PLR values for 338 stage I/II cHL patients and appropriate cut‐off point values to define progression. Two‐year freedom from progression (FFP) for patients with NLR ≥6·4 was 82·2% vs. 95·7% with NLR <6·4 (P < 0·001). Similarly, 2‐year FFP was 84·3% for patients with PLR ≥266·2 vs. 96·1% with PLR <266·2 (P = 0·003). On univariate analysis, both NLR and PLR were significantly associated with worse FFP (P = 0·001). On multivariate analysis, PLR remained a significant, independent prognostic factor (P < 0·001).     

Neutrophil/lymphocyte ratio but not platelet/lymphocyte ratio and mean platelet volume can be an indicator of subclinical inflammation in patients with Familial Mediterranean Fever

Aim of the work: To evaluate the value of three hematological indices to determine subclinical inflammation in Familial Mediterranean Fever (FMF) patients during attack-free period. Patients and methods: This study included 60 FMF patients without FMF-related symptoms or signs in the preceding month and 50 age and sex matched healthy control. Subclinical inflammation was defined as the presence of elevated C-reactive protein (CRP) > 5 mg/dL and/or serum amyloid A (SAA) levels > 6.4 mg/L in the absence of any FMF related clinical signs and symptoms. The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) were evaluated. Results: The median age of the patients was 32 and 80% were females. They were 12 (80%) with subclinical inflammation and 48 (80%) without. Mutations of MEFV gene were analyzed in 43 (56.6%) patients and were homozygous in 21, heterozygous in 12 and compound heterozygous in 10. The most common mutation was of M694V. The NLR and PLR were significantly higher and MPV lower in patients with inflammation (p = 0.002, p = 0.02, p = 0.03, respectively) but was comparable to the values in the control. Only NLR was significantly higher in those with inflammation compared to those without (p = 0.009) whereas MPV and PLR were similar (p = 0.45 and p = 0.22, respectively). The best cut-off value for NLR in predicting subclinical inflammation in patients was 2.94 (sensitivity 66.7%, specificity 94.9%;p = 0.009). Conclusions: Only NLR increased in FMF patients with subclinical inflammation which may be used as a marker in determining early activity or flare in addition to other markers.     

Prognostic value of preoperative platelet–lymphocyte and neutrophil–lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer

Increasing evidence has suggested that the host inflammatory status is associated with prognosis of several solid tumors. Preoperative platelet–lymphocyte ratio (PLR) and neutrophil–lymphocyte ratio (NLR), both acquired from routine blood tests, can reflect the status of systematic inflammation. However, whether they are correlated with clinical outcomes of esophageal carcinoma is still unknown. The purpose of this study was to determine the prognostic value of preoperative PLR and NLR in patients with resected esophageal squamous cell carcinoma (ESCC). Preoperative PLR and NLR were evaluated in 317 eligible ESCC patients from September 2008 to December 2010. Receiver operating characteristic curves were applied to establish optimal cutoff points. The prognostic values of PLR and NLR were determined by both univariate and multivariate analyses. The optimal cutoff value of preoperative PLR and NLR were 103.0 and 2.1, respectively. One hundred and ninety‐seven (62.1%) patients showed high level of preoperative PLR, while 148 (46.7%) patients showed high level of preoperative NLR. Both elevated PLR (P < 0.001) and NLR (P = 0.009) were correlated with poor disease‐specific survival in univariate analysis. However, only preoperative PLR (P = 0.003) had a significant correlation with prognosis in multivariate analysis. In subgroup analyses, the predictive value of PLR was significant for stage I (P = 0.008) and stage II (P = 0.044) patients, but not for stage III patients (P = 0.100). Preoperative PLR is easily obtained from a routine blood test and may provide additional prognostic information for ESCC patients, especially in the early stage.     

中性粒细胞/淋巴细胞比值对心肌梗死患者心肌灌注及预后的评估

目的观察中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）对判断急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗后患者的心肌灌注和预后的影响。方法选取接受直接PCI治疗的急性STEMI患者551例,根据入院第一次NLR,将患者按照四分位数法分成4组。比较各组患者临床特征、冠脉造影结果,入院30天内的死亡、心血管事件和校正的TIMI帧计数（CTFC）和TIMI心肌灌注分级（TMPG）。结果在NLR最高组中,患者年龄较大,入院舒张压偏低,Killip心功能分级Ⅱ至Ⅳ级患者比例较高（P〈0.05）,血清肌酐〉133μmol/L患者比例增加;双支病变和三支病变患者比例明显高于其他三组（P〈0.05）。同时,CTFC数值高于其他三组,TMPG0-1级比例亦显著增加。左室射血分数明显降低（P〈0.05）;PCI术后30天内的主要心血管事件以及死亡均高于其他3组,具有统计学意义,多元回归分析logNLR与30天内的主要心血管事件相关（r=2.27,P〈0.05）。结论入院时NLR较高的STEMI患者,PCI术后的其心肌灌注较差,且预后不良。     

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension.

Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1?±?10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3?±?12.7 years) had non-dipper hypertension.

Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3?±?0.9 versus 1.8?±?0.5, p?p?=?0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%.

Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.     

TACE联合CIK治疗晚期肝癌患者疗效评价

目的 探讨采用经肝动脉栓塞化疗术（TACE）联合应用细胞因子诱导的杀伤细胞（CIK）治疗晚期肝癌患者的临床疗效。方法 我科2012年1月～2013年12月住院的原发性肝癌患者60例,被随机分为两组。30例患者在TACE治疗基础上给予CIK治疗,另30例患者仅接受TACE治疗。取患者自体外周血或健康产妇分娩脐血行CIK培养。在TACE治疗10～15 d后给予CIK细胞悬液（含1.0×109个细胞）外周静脉输注,连续或隔日输注1次,共3次。结果 在治疗6 m时,联合组血清甲胎蛋白水平为（87.27±29.45） ng/ml,显著低于TACE组[（158.78±99.09） ng/ml,P＜0.05]|联合组肿瘤大小为（4.37±1.78）cm,也显著小于TACE组[（5.48±1.61）cm,P＜0.05]|治疗后3 m、6 m和9 m行影像学检查,联合组病灶无增多、增大,TACE组在治疗3 m后有4例出现肝内病灶增大|联合组2 a生存率为53.3%,显著高于TACE组的33.3%（P＜0.05）。结论 TACE联合CIK治疗晚期肝癌患者有一定的效果,患者耐受性良好,无严重不良反应,能明显提高患者生存率。     

急性冠状动脉综合征患者血清中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值水平对冠状动脉病变程度及院内主要不良心血管事件的评估价值

目的探讨急性冠状动脉综合征(ACS)患者中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)与冠状动脉狭窄程度及院内主要不良心血管事件(MACE)发生的关系。方法收集2018年4月至2020年4月于新疆医科大学第一附属医院初次行冠状动脉造影ACS患者(426例)的临床基本资料、实验室参数,根据住院MACE情况,将纳入的患者分为MACE组(104例)和无MACE组(322例)。根据Gensini评分的三分位数,将患者分为三组:低Gensini组(≤34分,143例),中Gensini组(34~58分,142例),高Gensini组(>58分,141例),使用t检验、方差分析、卡方检验、非参数Mann-Whitney U检验、Kruskal-Wallish H检验、logistic回归分析和受试者工作特性曲线等统计方法对数据进行分析。结果MACE组NLR[4.48(2.42,7.47)比2.82(1.79,4.70),P<0.001]和PLR[133.21(92.88,190.25)比101.03(75.33,134.01),P<0.001]显著高于无MACE组,差异有统计学意义。在基于Gensini评分分组的三组中,低Gensini组、中Gensini组、高Gensini组NLR[3.59(1.56,3.58)比3.47(1.94,5.73)比3.71(2.13,6.21),P<0.001]、PLR[93.98(66.03,127.94)比110.90(88.26,140.79)比120.37(84.58,174.54),P<0.001]比较,差异均有统计学意义。logistic回归分析显示,NLR(OR 1.189,95%CI 1.003~1.409,P=0.046;OR 1.102,95%CI 1.005~1.208,P=0.039)、PLR(OR 1.008,95%CI 1.002~1.014,P=0.021;OR 1.004,95%CI 1.002~1.009,P=0.042)是院内MACE和高Gensini评分的独立危险因素。NLR预测院内MACE发生的截断值为4.516,敏感度为50.00%,特异度为74.53%,曲线下面积(AUC)为0.633(95%CI 0.585~0.679,P<0.001);PLR预测院内MACE发生的截断值为153.103,敏感度为45.19%,特异度为84.78%,AUC为0.666(95%CI 0.619~0.711,P<0.001)。NLR预测高Gensini评分(>58分)的截断值为3.802,敏感度为49.62%,特异度为66.44%(AUC=0.600,95%CI 0.552~0.647,P<0.001);PLR预测高Gensini评分的截断值为153.543,敏感度为37.40%,特异度为84.75%(AUC=0.616,95%CI 0.567~0.662,P<0.001)。结论NLR、PLR作为一种新的炎症标志物,与ACS患者院内MACE的发生和冠状动脉狭窄的严重程度有显著的独立相关性。NLR、PLR作为一种容易获得且价格便宜的炎症指标,可作为有效的炎症标志物广泛应用于鉴别高危患者,从而有助于指导个体化治疗以改善ACS预后。     

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients

Objective: Although there have been extensive investigations on neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) in many diseases, their roles in systemic lupus erythematosus (SLE) remain unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in adult SLE patients and explore their clinical significance.

Methods: A retrospective study involving 154 adult SLE patients and 151 healthy controls was performed. All clinical characteristics of the SLE patients were extracted from their medical records. NLR, PLR, and MPV levels between SLE patients and healthy controls were compared, and correlations between these indexes and clinical characteristics were analyzed.

Results: Increased NLR, PLR, and MPV were observed in SLE patients. NLR was positively correlated with C-reaction protein (r?=?0.509, p?<?0.01), erythrocyte sedimentation rate (r?=?0.610, p?<?0.01), and SLE Disease Activity Index (SLEDAI) scores (r?=?0.471, p?<?0.01). PLR was positively correlated with SLEDAI scores (r?=?0.44, p?<?0.01). SLE patients with nephritis had higher NLR and PLR levels than those without nephritis (p?<?0.01, p?=?0.03). In addition, an NLR level of 2.065 was determined as predictive cut-off value of SLE (sensitivity 74.7%, specificity 77.5%, AUC?=?0.828). Multiple regression analysis suggested that NLR was independently associated with SLE disease activity.

Conclusions: NLR and PLR could reflect inflammatory response and disease activity in SLE patients.     

中性粒细胞淋巴细胞比值对急性呼吸窘迫综合征患者预后价值的研究

目的探索中性粒细胞淋巴细胞比值(NLR)在急性呼吸窘迫综合征(ARDS)中的预后作用。方法选取2016年1月至2018年10月期间就诊于苏州市相城区第二人民医院和苏州市立医院东区的ARDS患者并获取其临床信息。采用相关性分析和多因素回归分析、生存分析探索NLR与患者预后关系。结果共计纳入80例ARDS患者,NLR中位值为14。死亡患者年龄、有创机械通气比例、NLR和肌酐显著高于存活患者,而氧合指数和血浆白蛋白低于存活患者。NLR无论作为连续性变量(HR=1.011,95%CI:1.004~1.017,P=0.001),还是以14为界限的二分类变量(HR=1.532,95%CI:1.095~2.143,P=0.013),均是ARDS独立预后因子。NLR>14的ARDS患者的住院死亡率、28 d死亡率、90 d死亡率和有创机械通气比例均显著高于NLR≤14患者。结论ARDS确诊早期(24 h)NLR>14是其独立不良预后因子。