针对血液病量表评估酒精性肝硬化和非酒精性脂肪性肝病患者的研究。
Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales.
机构信息
Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland.
Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Chodźki 3, Poland.
出版信息
World J Gastroenterol. 2020 Dec 21;26(47):7538-7549. doi: 10.3748/wjg.v26.i47.7538.
BACKGROUND
Seeking potentially novel blood markers of liver fibrosis and steatosis is constantly of crucial importance. Despite a growing number of studies in this field of hepatology, a certain role of hematological indices in the course of liver disorders has not been fully elucidated, yet.
AIM
To evaluate a diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR) in the course of alcoholic liver cirrhosis (ALC) and nonalcoholic fatty liver disease (NAFLD).
METHODS
One hundred forty-two patients with ALC, 92 with NAFLD and 68 persons in control group were enrolled in the study. Hematological indices (NLR, PLR and MPR), indirect and direct markers of liver fibrosis (aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index, fibrosis-4, gamma-glutamyl transpeptidase to platelet ratio, procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin) were measured in each person. Model for end-stage liver disease (MELD) score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD.
RESULTS
MPR and NLR values in ALC patients were significantly higher in comparison to control group; PLR level was significantly lower. MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis. MPR, NLR and PLR correlated with MELD score. NLR level in NAFLD patients was significantly higher in comparison to controls. MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score. AUC values and proposed cut-offs for NLR, PLR and MPR in ALC patients were: 0.821 (> 2.227), 0.675 (< 70.445) and 0.929 (> 0.048), respectively. AUC values and proposed cut-offs for NLR, PLR and MPR in NAFLD group were: 0.725 (> 2.034), 0.528 (> 97.101) and 0.547 (> 0.038), respectively.
CONCLUSION
Hematological markers are inseparably connected with serological indices of liver fibrosis in ALC and NAFLD patients. MPR and NLR turned out to be the most powerful parameters in ALC patients.
背景
寻找潜在的新型肝纤维化和脂肪变性的血液标志物一直具有至关重要的意义。尽管在肝脏病学领域进行了越来越多的研究，但血液学指标在肝脏疾病过程中的作用尚未完全阐明。
目的
评估中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和平均血小板体积与血小板比值（MPR）在酒精性肝硬化（ALC）和非酒精性脂肪性肝病（NAFLD）中的诊断准确性。
方法
研究纳入了 142 例 ALC 患者、92 例 NAFLD 患者和 68 例对照组患者。测量了每位患者的血液学指标（NLR、PLR 和 MPR）、间接和直接肝纤维化标志物（天冬氨酸转氨酶与丙氨酸转氨酶比值、天冬氨酸转氨酶与血小板比值指数、纤维化-4、γ-谷氨酰转肽酶与血小板比值、I 型前胶原羧基末端前肽、III 型前胶原氨基末端前肽、转化生长因子-α、血小板衍生生长因子 AB、层粘连蛋白）。在 ALC 组中计算了终末期肝病模型（MELD）评分，在 NAFLD 患者中计算了 NAFLD 纤维化评分和 BARD 评分。应用受试者工作特征（ROC）曲线和曲线下面积（AUC）值评估了检测标志物的敏感性和特异性，并评估了在 ALC 和 NAFLD 中测量指标的建议截断值。
结果
与对照组相比，ALC 患者的 MPR 和 NLR 值显著升高，PLR 水平显著降低。MPR 和 NLR 与评估的间接和直接肝纤维化标志物相关。MPR、NLR 与 MELD 评分相关。与对照组相比，NAFLD 患者的 NLR 值显著升高。MPR 与间接肝纤维化标志物和 NAFLD 纤维化评分相关。在 ALC 患者中，NLR、PLR 和 MPR 的 AUC 值和建议截断值分别为：0.821（>2.227）、0.675（<70.445）和 0.929（>0.048）。在 NAFLD 组中，NLR、PLR 和 MPR 的 AUC 值和建议截断值分别为：0.725（>2.034）、0.528（>97.101）和 0.547（>0.038）。
结论
血液学标志物与 ALC 和 NAFLD 患者的血清纤维化标志物密切相关。MPR 和 NLR 是 ALC 患者中最有力的参数。
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