中性粒细胞/淋巴细胞比值在托珠单抗治疗类风湿关节炎疗效评估中的价值

摘要

目的 探讨中性粒细胞/淋巴细胞比值(NLR)在托珠单抗(TCZ)治疗类风湿关节炎(RA)疗效评估中的价值.方法 根据治疗后疾病活动度情况,将接受TCZ治疗24周以上的60例RA患者分为稳定组41例和复发组19例,比较两组患者治疗前、后稳定期NLR、红细胞沉降率(ESR)、C反应蛋白(CRP)、临床疾病活动指数(CDAI)及复发组患者治疗后稳定期和复发期上述指标的变化.结果 基线时两组患者性别、年龄、病程、NLR、ESR、CRP及CDAI等比较,差异均无统计学意义(P>0.05).两组患者TCZ治疗后稳定期的NLR、ESR、CRP及CDAI均较治疗前明显降低(P<0.05),但两组患者治疗后稳定期上述指标比较,差异均无统计学意义(P>0.05).与复发组稳定期相比,复发期患者肿胀关节和压痛关节数量均明显增加,CDAI、ESR、中性粒细胞计数及百分比和NLR均升高,淋巴细胞百分比降低(P<0.05);但CRP、PLT、Hb和淋巴细胞计数的变化均无统计学意义(P>0.05).复发期时复发组68.4% (13/19)的患者ESR升高;57.9% (11/19) CRP升高;21.1%(4/19)中性粒细胞计数下降;47.4%(9/19)淋巴细胞计数升高,94.7%(18/19) NLR上升,所有患者的CDAI均升高.结论 与CRP、ESR等传统指标相比,NLR作为更为简便、廉价、有效的客观检测指标,可与CDAI协同评估TCZ治疗RA的疗效.%Objective To investigate the value of neutrophil-to-lymphocyte ratio (NLR) for estimating treatment response of tocilizumab(TCZ) therapy in rheumatoid arthritis (RA). Methods Sixty RA patients treated with TCZ for more than 24 weeks were divided into stable group(41 cases) and flare group( 19 cases) according to disease activity after TCZ treatment. NLR, erythrocyte sedimentation rate (ESR), C-reactive protein(CRP) and clinical disease activity index (CDAI) were compared before and after treatment between the two groups and between stable and flare period in flare group. Results Gender,age,disease period, NLR, ESR, CRP and CDAI were not significantly different between the two groups at baseline ( P > 0.05 ). Compared with before TCZ therapy, NLR, ESR, CRP and CDAI all decreased significantly after therapy in the two groups during stable period ( P < 0.05 ). However, there were no significant differences of these indexes between the two groups during stable period ( P > 0.05 ). Compared with stable period in flare group, swollen joint count, tender joint count, CDAI, ESR, neutrophil count and its percentage as well as NLR all increased during flare period, while percentage of lymphocyte decreased(P <0.05 ). CRP, PLT, hemoglobin and percentage of lymphocyte did not change significantly (P >0.05 ). 68.4% (13/19) and 57.9% (11/19) of patients during flare period in flare group had higher ESR and CRP respectively. 21.1% (4/19) of them had lower neutrophil count and 47.4% (9/19) had higher lymphocyte count. 94.7% (18/19) of them had higher NLR,and CDAI increased in all of them. Conclusion Compared with CRP and ESR, NLR can be considered as a less expensive, but more convenient,reliable and objective marker for evaluating disease activity in RA patients treated with TCZ along with CDAI.