中性粒细胞/淋巴细胞比值、淋巴细胞/中性粒细胞比值与系统性红斑狼疮活动及狼疮肾炎的关系
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中性粒细胞/淋巴细胞比值、淋巴细胞/中性粒细胞比值与系统性红
斑狼疮活动及狼疮肾炎的关系
目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),淋巴细胞/中性粒细胞比值(lymphocyte to neutrophil ratio,LNR)与系统性红斑狼疮(systemic lupus erythematosus,SLE)疾病活动度、狼疮肾炎的关系。
方法回顾性分析我院SLE患者及健康对照组的资料,评估NLR、LNR与狼疮活动度及狼疮肾炎的关系。
结果37例患者及132例对照组中,有狼疮肾炎23例(占62.16%),重度活动组20例(占54.05%)。
狼疮患者NLR高于對照组(3.71±3.43 VS 1.75±0.63,P=0.000),LNR低于对照组(0.41±0.26 VS 0.64±0.22,P=0.000)。
狼疮肾炎患者NLR高于无狼疮肾炎患者(4.75±3.98 VS 2.00±0.80,P=0.004),LNR低于无狼疮肾炎患者(0.30±0.16 VS 0.60±0.29,P=0.003)。
24 h尿蛋白定量与LNR呈负相关(r=-0.443,P=0.006)。
重度活动患者NLR高于非重度活动患者(5.03±4.17 VS 2.15±1.01,P=0.007),LNR低于非重度活动患者(0.28±0.15 VS 0.57±0.28,P=0.001)。
SLEDAI评分与NLR呈正相关(r=0.330,P=0.046),与LNR呈负相关(r=-0.544,P=0.000)。
Logistic分析提示LNR是狼疮肾炎及狼疮重度活动的保护因素。
结论NLR可有效评估狼疮疾病活动度及肾脏受累,LNR 是狼疮肾炎与狼疮重度活动的保护因素。
Abstract:Objective To investigate the neutrophil/lymphocyte ratio(neutrophil to lymphocyte ratio,NLR),the ratio of neutrophils/lymphocytes (lymphocyte to neutrophil ratio,LNR)and systemic lupus erythematosus(systemic lupus erythematosus,SLE)disease activity,the relationship between lupus nephritis.Methods Retrospective analysis of SLE patients and healthy control group the data,assessment of NLR,the relationship between LNR and lupus activity and lupus nephritis.Results 37 cases and 132 cases in the control group,with 23 cases of lupus nephritis(62.16%),severe group 20 cases(54.05%).The level of NLR in patients with lupus was higher than that in the control group(3.71±3.43vs1.75±0.63,P=0.000)and LNR was lower than that in the control group(0.41±0.26vs0.64±0.22,P=0.000).The level of NLR in patients with lupus nephritis was higher than that in patients without lupus nephritis(4.75±3.98vs2.00±0.80,P=0.004)and LNR was lower than that in patients without lupus nephritis (0.30±0.16vs0.60±0.29,P= 0.003).24 h urinary protein was negatively correlated with LNR(r=-0.443,P=0.006).The level of NLR in patients with severe activity was higher than that in non-severe patients (5.03±4.17vs2.15±1.01,P=0.007)and LNR was lower than that in non-severe patients(0.28±0.15vs0.57±0.28,P=0.001).The SLEDAI score was positively correlated with NLR(r=0.330,P=0.046)and negatively correlated with LNR (r=-0.544,P=0.000).Logistic analysis suggested that LNR was a protective factor for lupus nephritis and severe lupus erythematosus.Conclusion NLR can effectively evaluate the activity of lupus disease and kidney involvement.LNR is a protective factor of lupus nephritis and severe activity of lupus erythematosus.3 讨论
NLR作为一个易于获取和分析的炎症标记物,在恶性肿瘤、心脑血管病、糖尿病等与炎症相关的疾病中被广泛研究,并被认为与非肿瘤性疾病的总体生存率密切相关,NLR越高,预示着生存率越低[7]。
从本研究看,狼疮患者NLR高于对照组,该结果与Wu Y等[8],Qin B等[9]、Li L等[10] 及刘晓庆等[11]的研究相一致。
这提示狼疮患者体内炎症状态明显,狼疮的发病与炎症关系密切。
另外,我们发现重度活动性狼疮患者(SLEDAI评分≥15分)的NLR显著高于非重度活动性狼疮患者,且NLR与SLEDAI评分成线性正相关。
Wu Y等[8]发现SLEDAI评分>9分的狼疮患者NLR高于SLEDAI评分≤9分的狼疮患者,且NLR与SLEDAI评分成线性正相关。
Qin B等[9]也发现NLR与SLEDAI评分成线性正相关,本研究与其他研究均提示NLR与狼疮的活动密切相关,可作为评估狼疮活动度的辅助指标。
刘晓庆等[11]虽未发现NLR与SLEDAI评分成正相关,但发现NLR与血清补体C3、C4成正相关,与Treg细胞计数呈负相关。
这提示NLR这个炎症指标与狼疮活动的免疫指标相关,在狼疮的活动过程中,可能存在炎症细胞与免疫细胞之间复杂的相互作用。
同时,我们发现狼疮肾炎患者较无肾炎患者,NLR更高。
本研究结果与Wu Y等[8],Qin B等[9]、Li L等[10]的研究可相互印证。
这提示炎症状态的加重及炎症细胞(如中性粒细胞)的参与可能与重要脏器(如肾脏)的受累有关。
然而,我们发现,与NLR相比,LNR与狼疮活动度(以SLEDAI评分为参考)相关性更好(R2=0.296 VS 0.109),可作为狼疮活动的负相关因素,而Logistic 回归也发现,只有LNR可作为狼疮重度活动及狼疮肾炎的保护因素。
另外,我们发现LNR与24 h尿蛋白定量负相关(r=-0.443),却未能发现NLR与24 h尿蛋白定量之间的相关性。
且Logistic回归发现,只有LNR可作为狼疮肾炎的保护因素,也未能发现NLR作为狼疮肾炎的促进因素。
这些均提示LNR可能与狼疮的活动性、狼疮肾炎的关系更为密切,可作为狼疮发生、活动及重要脏器损害的保护因素。
本研究也有一些缺陷:第一是患者数少,关于NLR的研究结果虽与其他研究的结果相一致,但关于LNR是否更与疾病的活动度和尿蛋白定量相关,还需要其他样本及更大样本的检验。
二是该研究为横断面研究,若要更好的说明NLR、LNR在狼疮肾炎及狼疮活动中的作用,应再做纵向研究,动态观察患者病情变化前后这两个指标的变化情况。
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