Nishida Yu, Hosomi Shuhei, Yamagami Hirokazu, Yukawa Tomomi, Otani Koji, Nagami Yasuaki, Tanaka Fumio, Taira Koichi, Kamata Noriko, Tanigawa Tetsuya, Shiba Masatsugu, Watanabe Kenji, Watanabe Toshio, Tominaga Kazunari, Fujiwara Yasuhiro
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.
PLoS One. 2017 Jan 11;12(1):e0169845. doi: 10.1371/journal.pone.0169845. eCollection 2017.
Neutrophil-to-lymphocyte ratio (NLR) has been used to determine the outcome in malignancies and coronary heart disease. Some reports considered the value of NLR as a predictor of response to infliximab in patients with Crohn's disease or rheumatoid arthritis; however, no similar studies have been reported for ulcerative colitis (UC). This study aimed to evaluate the clinical significance of the baseline NLR in patients with UC treated by infliximab.
Patients with moderate-to-severe active UC who received the first infliximab infusion in our hospital between 2010 and 2015, who showed clinical response during the induction period, were retrospectively evaluated for long-term outcomes and risk factors for loss of response (LOR) during infliximab maintenance therapy. Baseline inflammatory markers including NLR were measured within one week before the initiation of infliximab.
Fifty-nine patients with moderate-to-severe active UC started treatment with infliximab and 37 patients (62.7%) experienced clinical response after induction therapy. Fourteen of 37 patients on maintenance therapy lost the response during follow-up. Baseline NLR of patients with LOR was significantly higher than in patients with sustained response. The NLR cut-off value of 4.488 was predictive of LOR, using receiver operating characteristic analysis (sensitivity: 78.6%, specificity: 78.3%). A univariate analysis revealed a significant relationship between relapse-free survival and the NLR (P = 0.018). Multivariate analysis indicated the NLR as an independent prognostic factor for LOR (hazard ratio = 3.86, 95% confidence interval: 1.20-12.4, P = 0.023).
Baseline NLR is a useful prognostic marker in patients with moderate-to-severe active UC treated with infliximab, and may contribute to appropriate use of infliximab.
中性粒细胞与淋巴细胞比值（NLR）已被用于确定恶性肿瘤和冠心病的预后。一些报告认为NLR值可作为克罗恩病或类风湿关节炎患者对英夫利昔单抗反应的预测指标；然而，尚未有关于溃疡性结肠炎（UC）的类似研究报道。本研究旨在评估英夫利昔单抗治疗的UC患者基线NLR的临床意义。
回顾性评估2010年至2015年间在我院接受首次英夫利昔单抗输注、诱导期有临床反应的中重度活动性UC患者的长期预后及英夫利昔单抗维持治疗期间反应丧失（LOR）的危险因素。在英夫利昔单抗治疗开始前一周内测量包括NLR在内的基线炎症标志物。
59例中重度活动性UC患者开始接受英夫利昔单抗治疗，37例患者（62.7%）在诱导治疗后有临床反应。37例维持治疗患者中有14例在随访期间失去反应。LOR患者的基线NLR显著高于持续有反应的患者。使用受试者工作特征分析，NLR临界值为4.488可预测LOR（敏感性：78.6%，特异性：78.3%）。单因素分析显示无复发生存与NLR之间存在显著关系（P = 0.018）。多因素分析表明NLR是LOR的独立预后因素（风险比 = 3.86，95%置信区间：1.20 - 12.4，P = 0.023）。
基线NLR是接受英夫利昔单抗治疗的中重度活动性UC患者的有用预后标志物，可能有助于英夫利昔单抗的合理使用。
