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*

doi:10.3969/j.issn.1672-5069.2022.03.016

摘要/Abstract

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。

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

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/L[OR(95%CI):1.7(1.2-2.5)], ALP≥327.6 U/L[OR(95%CI):1.9(1.2-2.8)], the RDW≥14.8%[OR(95%CI):1.9(1.2-2.8)] and NLR≥1.8[OR(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.

Key words: Primary biliary cholangitis, Red blood cell distribution width, Neutrophil to lymphocyte ratio, Liver damage, Prediction

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.

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 Practical Hepatology, 2022, 25(3): 367-370.

参考文献

[1] Wu J, Zhang X, Liu H, et al. RDW, NLR and RLR in predicting liver failure and prognosis in patients with hepatitis E virus infection. Clin Biochem, 2019, 63(1):24-31.
[2] Han F, Shang X, Wan F, et al. Clinical value of the preoperative neutrophil-to-lymphocyte ratio andred blood cell distribution width in patients with colorectal carcinoma. Oncol Lett, 2018, 15(3):3339-3349.
[3] Sun X, Luo L, Zhao X, et al. The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age. BMC Cardiovasc Disord, 2017, 17(1):167.
[4] Bozan N, Kocak F, Dinc ME, et al. Mean platelet volume, red cell distribution width, and neutrophil-to-lymphocyte ratio before and after surgery in patients with carotid body tumors. J Craniofac Surg, 2017, 28(7):e649-e653.
[5] 中华医学会肝病学分会、消化病学分会、感染病学分会.胆汁淤积性肝病诊断和治疗共识(2015年).实用肝脏病杂志,2016,19(6):Ⅰ-ⅩⅠ.
[6] 孙钟武, 耿宏, 郭刚. 术前中性粒细胞与淋巴细胞比值在临床评估急性胆管炎伴胆总管结石患者病情中的价值. 中华卫生应急电子杂志, 2019, 5(6):341-343.
[7] 王培, 张青, 李颍, 等. 基于红细胞分布宽度和中性粒细胞/淋巴细胞比值建立慢加急性乙型肝炎肝衰竭患者短期预后预测模型价值研究. 实用肝脏病杂志, 2020, 23(5):682-686.
[8] Yu H, Jiang L, Yao L, et al. Predictive value of the neutrophil to lymphocyte ratio and hemoglobin insystemic lupus erythematosus. Exp Ther Med, 2018, 16(2):1547-1553.
[9] Zhang X, Wang D, Chen Z, et al. Red celldistribution width-to-lymphocyte ratio: A novel predictor for HBV-related liver cirrhosis. Medicine, 2020, 99(23):e20638.
[10] 蔡林灵, 颜海希, 金高兵, 等. 红细胞分布宽度和中性粒细胞数/淋巴细胞数比值与原发性胆汁性肝硬化患者疾病预后的相关性. 中华临床免疫和变态反应杂志, 2016,2310):125-130.
[11] Huang R, Wang G, Tian C, et al. Gamma-glutamyl-transpeptidase to platelet ratio is not superior to APRI,FIB-4 and RPR for diagnosing liver fibrosis in CHB patients in China. Sci Rep, 2017, 7(1):8543.
[12] Li X, Wu J, Mao W. Evaluation of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red cell distribution width for the prediction of prognosis of patients with hepatitis B virus-related decompensated cirrhosis. J Clin Lab Anal, 2020, 34(11):e23478.
[13] 金蕾, 李旭, 叶珺, 等. 红细胞分布宽度对丙型肝炎相关肝病进展评估的价值. 中华肝脏病杂志, 2016, 24(2):130-132.
[14] Xiang Z J, Hu T, Wang Y, et al. Neutrophil–lymphocyte ratio(NLR) was associated with prognosis and immunomodulatory in patients with pancreatic ductal adenocarcinoma (PDAC). Biosci Rep, 2020, 40(6):BSR20201190.
[15] 王佳, 林雪容, 高恒波,等. 快速序贯器官功能衰竭评分联合红细胞分布宽度对老年脓毒症患者预后的预测价值. 中华老年多器官疾病杂志, 2021, 20(1):30-34.
[16] Fu S J, Ji F, Han M, et al. Prognostic value of combined preoperative fibrinogen and neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma after liver transplantation. Oncotarget, 2017, 8(3):4301-4312.
[17] Marchioni M, Primiceri G, Ingrosso M, et al. The clinical use of the neutrophil to lymphocyte ratio (NLR) in urothelial cancer: A systematic review. Clin Genitourin Cancer, 2016, 14(6):473-484.
[18] 吴健, 成娟, 宋曙, 等. 红细胞分布宽度及红细胞分布宽度与血小板比值在HEV相关肝衰竭患者诊断及预后中的价值评估. 中华临床感染病杂志, 2020, 13(6):434-438.
[19] Miyahara Y, Takashi S, Shimizu Y, et al. The prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with distal bile duct cancer. World J Surg Oncol, 2020, 18(1):78.
[20] Guo Q, Shao Z, Xu D, et al. Prognostic value of neutrophil-to-lymphocyte ratio in peripheral blood and pathological tissue in patients with esophageal squamous cell carcinoma. MMedicine (Baltimore), 2020, 99(29):e21306.
[21] Rutkowski P, Lugowska I, Klimczak A, et al. The prognostic value of blood neutrophil-to-lymphocyte ratio (NLR) factor in advanced gastrointestinal stromal tumors (GIST) treated with sunitinib after imatinib failure. J Clin Oncol, 2018, 36(15):11531-11531.
[22] Sarlak H, Arslan E, Cakar M, et al. Relation between unconjugated bilirubin and RDW, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio in Gilbert's syndrome. SpringerPlus, 2016, 5(1):1392.

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^*

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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