Ha You-Jung, Hur Jaehyung, Go Dong Jin, Kang Eun Ha, Park Jin Kyun, Lee Eun Young, Shin Kichul, Lee Eun Bong, Song Yeong Wook, Lee Yun Jong
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
PLoS One. 2018 Jan 2;13(1):e0190411. doi: 10.1371/journal.pone.0190411. eCollection 2018.
Recent studies have suggested that neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) are emerging markers of disease activity and prognosis in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. Therefore, we investigated the clinical significance and prognostic value of the NLR and CAR in adult patients with polymyositis and dermatomyositis. The medical records of 197 patients with newly diagnosed polymyositis/dermatomyositis between August 2003 and November 2016 were retrospectively reviewed. Survival and causes of death were recorded during an average 33-month observational period. Clinical and laboratory findings were compared between survivors and non-survivors. Using receiver operating characteristic curves, the NLR and CAR cut-off values for predicting survival were calculated. Univariate and multivariate analyses using Cox proportional hazard models were performed to identify factors associated with survival. Twenty-six patients (13.2%) died during the study period, and the 5-year survival-rate was estimated to be 82%. The non-survivor group exhibited older age and a higher prevalence of interstitial lung disease (ILD), acute interstitial pneumonia, and acute exacerbation of ILD compared to that in the survivor group. NLR and CAR values were significantly higher in the non-survivors and in patients with polymyositis/dermatomyositis-associated ILD, and the death rates increased across NLR and CAR quartiles. Furthermore, when stratified according to the NLR or CAR optimal cut-off values, patients with a high NLR (>4.775) or high CAR (>0.0735) had a significantly lower survival rate than patients with low NLR or CAR, respectively. In addition, old age (>50 years), the presence of acute interstitial pneumonia, hypoproteinemia (serum protein <5.5 g/dL), and high NLR (but not high CAR) were independent predictors for mortality. The results indicate that a high NLR is independently associated with worse overall survival. Thus, the baseline NLR level may be a simple, cost-effective prognostic marker in patients with polymyositis/dermatomyositis.
近期研究表明，中性粒细胞与淋巴细胞比值（NLR）及C反应蛋白与白蛋白比值（CAR）正成为慢性炎症性疾病、心血管疾病或恶性肿瘤患者疾病活动度及预后的标志物。因此，我们研究了NLR和CAR在成年多发性肌炎和皮肌炎患者中的临床意义及预后价值。回顾性分析了2003年8月至2016年11月期间197例新诊断的多发性肌炎/皮肌炎患者的病历。在平均33个月的观察期内记录生存情况及死亡原因。比较了幸存者与非幸存者的临床及实验室检查结果。利用受试者工作特征曲线计算预测生存的NLR和CAR临界值。采用Cox比例风险模型进行单因素和多因素分析以确定与生存相关的因素。研究期间26例患者（13.2%）死亡，估计5年生存率为82%。与幸存者组相比，非幸存者组年龄更大，间质性肺疾病（ILD）、急性间质性肺炎及ILD急性加重的患病率更高。非幸存者及合并多发性肌炎/皮肌炎相关ILD的患者NLR和CAR值显著更高，且NLR和CAR四分位数范围内的死亡率均升高。此外，根据NLR或CAR最佳临界值分层时，NLR高（>4.775）或CAR高（>0.0735）的患者生存率分别显著低于NLR或CAR低的患者。此外，老年（>50岁）、急性间质性肺炎、低蛋白血症（血清蛋白<5.5 g/dL）及高NLR（而非高CAR）是死亡的独立预测因素。结果表明，高NLR与总体生存较差独立相关。因此，基线NLR水平可能是多发性肌炎/皮肌炎患者一种简单、经济有效的预后标志物。
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