Oh Lawrence J, Wong Eugene, Andrici Juliana, McCluskey Peter, Smith James E H, Gill Anthony J
Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2018 Apr;48(4):408-413. doi: 10.1111/imj.13713.
Temporal artery biopsy is considered the investigation of choice to diagnose definitively giant cell arteritis (GCA) in patients with compatible symptoms. However it is invasive and not completely sensitive. Serum markers, particularly erythrocyte sedimentation rate (ESR), can be supportive, but are not definitive in individual cases.
To investigate whether indices derived from the full blood count, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with a positive biopsy in patients with suspected GCA.
The clinical and pathological details of 537 patients undergoing temporal artery biopsy at our institution from 1992 to 2015 were reviewed.
In univariate analysis high platelets (odds ratio (OR) 4.44, P < 0.001), NLR (OR 1.81, P = 0.02), PLR (OR 3.25, P < 0.001), C-reactive protein (CRP) (OR 3.00, P < 0.001), ESR (OR 3.62, P < 0.001) and increased age (OR 1.03, P = 0.006) were strongly associated with a positive biopsy. In multivariate modelling only high platelets (P < 0.001) and ESR (P = 0.049) maintained significance.
We conclude that the presence of thrombocytosis and high NLR, PLR, ESR and CRP can all be used clinically to support the diagnosis of GCA prior to biopsy. Of particular note, in multivariate modelling the presence of thrombocytosis is a stronger predictor of a positive temporal artery biopsy than ESR. Therefore, careful consideration of the findings in a full blood count can be used to predict the likelihood of a positive temporal artery biopsy in patients with suspected GCA.
颞动脉活检被认为是确诊有相关症状患者巨细胞动脉炎（GCA）的首选检查方法。然而，该检查具有侵入性且并非完全敏感。血清标志物，尤其是红细胞沉降率（ESR），可提供支持，但在个别病例中并不具有决定性意义。
研究全血细胞计数得出的指标，包括中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR），是否与疑似GCA患者活检呈阳性相关。
回顾了1992年至2015年在我院接受颞动脉活检的537例患者的临床和病理细节。
单因素分析显示，高血小板（比值比（OR）4.44，P<0.001）、NLR（OR 1.81，P = 0.02）、PLR（OR 3.25，P<0.001）、C反应蛋白（CRP）（OR 3.00，P<0.001）、ESR（OR 3.62，P<0.001）以及年龄增加（OR 1.03，P = 0.006）与活检呈阳性密切相关。多因素模型分析中，只有高血小板（P<0.001）和ESR（P = 0.049）仍具有显著意义。
我们得出结论，血小板增多以及高NLR、PLR、ESR和CRP的存在均可在临床上用于在活检前支持GCA的诊断。特别值得注意的是，在多因素模型分析中，血小板增多比ESR更能预测颞动脉活检呈阳性。因此，仔细考虑全血细胞计数结果可用于预测疑似GCA患者颞动脉活检呈阳性的可能性。
