McGovern Medical School at University of Texas Health Science Center, Houston.
University of California, Los Angeles.
Arthritis Care Res (Hoboken). 2023 Mar;75(3):648-656. doi: 10.1002/acr.24880. Epub 2022 Nov 17.
To assess the predictive significance of blood neutrophil count and the ratio between neutrophil and lymphocyte count (neutrophil-to-lymphocyte ratio [NLR]) for disease severity and mortality in systemic sclerosis (SSc).
Neutrophil and lymphocyte counts were prospectively measured in the Genetics versus Environment in Scleroderma Outcome Study (GENISOS) and the Scleroderma Lung Study II (SLS II). Forced vital capacity percent predicted (FVC%) and modified Rodnan skin thickness score (MRSS) were used as surrogate measures for disease severity. Longitudinal analyses were performed using generalized linear mixed models. Cox proportional hazards models evaluated the predictive significance of these cell counts for mortality.
Of the 447 SSc patients in the GENISOS cohort at the time of analysis, 377 (84.3%) had available baseline blood neutrophil and lymphocyte counts. Higher baseline neutrophil count and NLR predicted lower serially obtained FVC% (b = -4.74, P = 0.009 and b = -2.68, P = 0.028, respectively) and higher serially obtained MRSS (b = 4.07, P < 0.001 and b = 2.32, P < 0.001, respectively). Longitudinal neutrophil and NLR measurements also significantly correlated with lower concurrently obtained FVC% measurements and higher concurrently obtained MRSS. Baseline neutrophil count and NLR predicted increased risk of long-term mortality, even after adjustment for baseline demographic and clinical factors (hazard ratio [HR] 1.42, P = 0.02 and HR 1.48, P < 0.001, respectively). The predictive significance of higher baseline neutrophil count and NLR for declining FVC% and increased long-term mortality was confirmed in the SLS II.
Higher blood neutrophil count and NLR are predictive of more severe disease course and increased mortality, indicating that these easily obtainable laboratory studies might be a reflection of pathologic immune processes in SSc.
评估血液中性粒细胞计数和中性粒细胞与淋巴细胞计数比值（中性粒细胞与淋巴细胞比值[NLR]）对系统性硬化症（SSc）疾病严重程度和死亡率的预测意义。
在遗传学与环境对硬皮病结局研究（GENISOS）和硬皮病肺研究 II（SLS II）中前瞻性测量了中性粒细胞和淋巴细胞计数。用力肺活量占预计值百分比（FVC%）和改良罗达恩皮肤厚度评分（MRSS）被用作疾病严重程度的替代指标。使用广义线性混合模型进行纵向分析。Cox 比例风险模型评估了这些细胞计数对死亡率的预测意义。
在分析时，GENISOS 队列中的 447 例 SSc 患者中，377 例（84.3%）有基线血液中性粒细胞和淋巴细胞计数。较高的基线中性粒细胞计数和 NLR 预测了较低的 FVC%（b=-4.74，P=0.009 和 b=-2.68，P=0.028）和较高的 MRSS（b=4.07，P<0.001 和 b=2.32，P<0.001）。纵向中性粒细胞和 NLR 测量值也与同时获得的较低的 FVC%测量值和较高的同时获得的 MRSS 显著相关。基线中性粒细胞计数和 NLR 预测了长期死亡率的增加风险，即使在调整基线人口统计学和临床因素后（风险比[HR] 1.42，P=0.02 和 HR 1.48，P<0.001）。较高的基线中性粒细胞计数和 NLR 对 FVC%下降和长期死亡率增加的预测意义在 SLS II 中得到了证实。
较高的血液中性粒细胞计数和 NLR 与更严重的疾病过程和更高的死亡率相关，表明这些易于获得的实验室研究可能反映了 SSc 中病理免疫过程。
