Azab Basem, Camacho-Rivera Marlene, Taioli Emanuela
Department of Surgery, Staten Island University Hospital, Staten Island, New York, United States of America.
Department of Population Health, North Shore LIJ-Hofstra School of Medicine, Great Neck, New York, United States of America.
PLoS One. 2014 Nov 6;9(11):e112361. doi: 10.1371/journal.pone.0112361. eCollection 2014.
Several studies reported the negative impact of elevated neutrophil/lymphocyte ratio (NLR) on outcomes in many surgical and medical conditions. Previous studies used arbitrary NLR cut-off points according to the average of the populations under study. There is no data on the average NLR in the general population. The aim of this study is to explore the average values of NLR and according to race in adult non-institutional United States individuals by using national data.
The National Health and Nutrition Examination Survey (NHANES) of aggregated cross-sectional data collected from 2007 to 2010 was analyzed; data extracted included markers of systemic inflammation (neutrophil count, lymphocyte count, and NLR), demographic variables and other comorbidities. Subjects who were prescribed steroids, chemotherapy, immunomodulators and antibiotics were excluded. Adjusted linear regression models were used to examine the association between demographic and clinical characteristics and neutrophil counts, lymphocyte counts, and NLR.
Overall 9427 subjects are included in this study. The average value of neutrophils is 4.3 k cells/mL, of lymphocytes 2.1k cells/mL; the average NLR is 2.15. Non-Hispanic Black and Hispanic participants have significantly lower mean NLR values (1.76, 95% CI 1.71-1.81 and 2.08, 95% CI 2.04-2.12 respectively) when compared to non-Hispanic Whites (2.24, 95% CI 2.19-2.28-p<0.0001). Subjects who reported diabetes, cardiovascular disease, and smoking had significantly higher NLR than subjects who did not. Racial differences regarding the association of smoking and BMI with NLR were observed.
This study is providing preliminary data on racial disparities in a marker of inflammation, NLR, that has been associated with several chronic diseases outcome, suggesting that different cut-off points should be set according to race. It also suggests that racial differences exist in the inflammatory response to environmental and behavioral risk factors.
多项研究报告了中性粒细胞/淋巴细胞比值（NLR）升高对许多外科和内科疾病预后的负面影响。以往的研究根据所研究人群的平均值使用任意的NLR截断点。目前尚无关于普通人群平均NLR的数据。本研究的目的是利用全国数据探索美国成年非机构化人群中NLR的平均值及种族差异。
分析了2007年至2010年收集的全国健康和营养检查调查（NHANES）的汇总横断面数据；提取的数据包括全身炎症标志物（中性粒细胞计数、淋巴细胞计数和NLR）、人口统计学变量和其他合并症。排除使用类固醇、化疗、免疫调节剂和抗生素的受试者。采用调整后的线性回归模型来研究人口统计学和临床特征与中性粒细胞计数、淋巴细胞计数和NLR之间的关联。
本研究共纳入9427名受试者。中性粒细胞的平均值为4.3k个细胞/毫升，淋巴细胞为2.1k个细胞/毫升；平均NLR为2.15。与非西班牙裔白人（2.24，95%可信区间2.19 - 2.28，p<0.0001）相比，非西班牙裔黑人和西班牙裔参与者的平均NLR值显著较低（分别为1.76，95%可信区间1.71 - 1.81和2.08，95%可信区间2.04 - 2.12）。报告患有糖尿病、心血管疾病和吸烟的受试者的NLR显著高于未患这些疾病的受试者。观察到吸烟和体重指数与NLR关联的种族差异。
本研究提供了关于炎症标志物NLR种族差异的初步数据，NLR与多种慢性疾病预后相关，提示应根据种族设定不同的截断点。这也表明在对环境和行为危险因素的炎症反应中存在种族差异。
