Zhang Xueyan, Wang Dawei, Chen Zhongming, Guo Naizhou, Wang Wei, Xiong Cunquan, Liu Jun, Yue Yinhong, Sun Mingzhong
Department of Public Health, Jiangsu Vocational College of Medicine.
Department of Infectious Disease, The Second People's Hospital of Yancheng City.
Medicine (Baltimore). 2020 Jun 5;99(23):e20638. doi: 10.1097/MD.0000000000020600.
To evaluate the diagnostic power of red cell distribution width-to-lymphocyte ratio (RLR) for HBV-related liver cirrhosis via a retrospective cohort study.Seven hundred fifty healthy controls, 327 chronic hepatitis B (CHB) patients, and 410 patients with HBV-related liver cirrhosis (HBV-LC) were enrolled in this study. RLR, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), AST to platelet ratio index (APRI), and fibrosis index based on the 4 factors (FIB-4) were compared between the 3 groups. The predictive powers of RLR and RDW for HBV-related liver cirrhosis and patient prognosis were evaluated using AUROC.Patients with HBV-related liver cirrhosis had higher RLR, FIB-4, NLR, RDW, APRI, and lower LMR compared with the control and CHB groups. RLR in the HBV-LC group was significantly higher than both CHB and control groups (both P < .05). While RLR in the CHB group was also higher than the control group, the difference was not statistically significant (P > .05). The AUROC of RLR for predicting HBV-related liver cirrhosis was 0.87, and was superior to RDW (0.81), FIB-4 (0.79), and APRI (0.60). With an optimized cut-off value (10.87), RLR had the highest sensitivity (0.88) and specificity (0.72), and was superior to RDW (0.86, 0.64), FIB-4 (0.80, 0.65), and APRI (0.85, 0.48) as a biomarker. For all 3 groups, RLR was negatively correlated (all P < .05) with serum platelet (PLT) and was positively correlated (all P < .05) with FIB-4 and APRI. There was no significant statistical difference in RLR for patients in HBV-LC group who had different prognosis (P > .05).The RLR, a routinely available, inexpensive, and easily calculated measure, can be used as a predictor of HBV-related liver cirrhosis, but not as a predictor of prognosis for patients with liver cirrhosis. Use of RLR may reduce the need for frequent liver biopsies in CHB patients.
通过一项回顾性队列研究评估红细胞分布宽度与淋巴细胞比值（RLR）对乙肝相关肝硬化的诊断效能。本研究纳入了750名健康对照者、327名慢性乙型肝炎（CHB）患者和410名乙肝相关肝硬化（HBV-LC）患者。比较了三组之间的RLR、淋巴细胞与单核细胞比值（LMR）、中性粒细胞与淋巴细胞比值（NLR）、红细胞分布宽度（RDW）、AST与血小板比值指数（APRI）以及基于4项因子的纤维化指数（FIB-4）。使用受试者工作特征曲线下面积（AUROC）评估RLR和RDW对乙肝相关肝硬化及患者预后的预测能力。与对照组和CHB组相比，乙肝相关肝硬化患者的RLR、FIB-4、NLR、RDW、APRI更高，而LMR更低。HBV-LC组的RLR显著高于CHB组和对照组（均P<0.05）。虽然CHB组的RLR也高于对照组，但差异无统计学意义（P>0.05）。RLR预测乙肝相关肝硬化的AUROC为0.87，优于RDW（0.81）、FIB-4（0.79）和APRI（0.60）。采用优化的截断值（10.87）时，RLR具有最高的敏感性（0.88）和特异性（0.72），作为生物标志物优于RDW（0.86，0.64）、FIB-4（0.80，0.65）和APRI（0.85，0.48）。对于所有三组，RLR与血清血小板（PLT）呈负相关（均P<0.05），与FIB-4和APRI呈正相关（均P<0.05）。HBV-LC组中预后不同的患者其RLR无显著统计学差异（P>0.05）。RLR是一种常规可用、成本低廉且易于计算的指标，可作为乙肝相关肝硬化的预测指标，但不能作为肝硬化患者预后的预测指标。使用RLR可能会减少CHB患者频繁进行肝活检的需求。
