Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
Front Immunol. 2024 May 10;15:1395993. doi: 10.3389/fimmu.2024.1395993. eCollection 2024.
The identification of new, easily measurable biomarkers might assist clinicians in diagnosing and managing systemic sclerosis (SSc). Although the full blood count is routinely assessed in the evaluation of SSc, the diagnostic utility of specific cell-derived inflammatory indices, i.e., neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), has not been critically appraised in this patient group.
We conducted a systematic review and meta-analysis of studies investigating the NLR, PLR, and MLR, in SSc patients and healthy controls and in SSc patients with and without relevant complications. PubMed, Scopus, and Web of Science were searched from inception to 23 February 2024. Risk of bias and certainty of evidence were assessed using validated tools.
In 10 eligible studies, compared to controls, patients with SSc had significantly higher NLR (standard mean difference, SMD=0.68, 95% CI 0.46 to 0.91, p<0.001; I = 74.5%, p<0.001), and PLR values (SMD=0.52, 95% CI 0.21 to 0.83, p=0.001; I = 77.0%, p=0.005), and a trend towards higher MLR values (SMD=0.60, 95% CI -0.04 to 1.23, p=0.066; I = 94.1%, p<0.001). When compared to SSc patients without complications, the NLR was significantly higher in SSc with interstitial lung disease (ILD, SMD=0.31, 95% CI 0.15 to 0.46, p<0.001; I = 43.9%, p=0.11), pulmonary arterial hypertension (PAH, SMD=1.59, 95% CI 0.04 to 3.1, p=0.045; I = 87.6%, p<0.001), and digital ulcers (DU, SMD=0.43, 95% CI 0.13 to 0.74, p=0.006; I = 0.0%, p=0.49). The PLR was significantly higher in SSc patients with ILD (SMD=0.42, 95% CI 0.25 to 0.59, p<0.001; I = 24.8%, p=0.26). The MLR was significantly higher in SSc patients with PAH (SMD=0.63, 95% CI 0.17 to 1.08, p=0.007; I = 66.0%, p=0.086), and there was a trend towards a higher MLR in SSc patients with ILD (SMD=0.60, 95% CI -0.04 to 1.23, p=0.066; I = 94.1%, p<0.001).
Pending the results of appropriately designed prospective studies, the results of this systematic review and meta-analysis suggest that blood cell-derived indices of inflammation, particularly the NLR and PLR, may be useful in the diagnosis of SSc and specific complications.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024520040.
识别新的、易于测量的生物标志物可能有助于临床医生诊断和管理系统性硬化症（SSc）。虽然全血细胞计数在 SSc 的评估中常规进行，但特定细胞衍生炎症指标的诊断效用，即中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和单核细胞与淋巴细胞比值（MLR），在该患者群体中尚未得到严格评估。
我们对研究 NLR、PLR 和 MLR 的 SSc 患者和健康对照组以及有和没有相关并发症的 SSc 患者的研究进行了系统评价和荟萃分析。从开始到 2024 年 2 月 23 日，我们在 PubMed、Scopus 和 Web of Science 上进行了搜索。使用经过验证的工具评估偏倚风险和证据确定性。
在 10 项合格研究中，与对照组相比，SSc 患者的 NLR（标准均数差，SMD=0.68，95%置信区间 0.46 至 0.91，p<0.001；I=74.5%，p<0.001）和 PLR 值（SMD=0.52，95%置信区间 0.21 至 0.83，p=0.001；I=77.0%，p=0.005）显著更高，并且 MLR 值呈升高趋势（SMD=0.60，95%置信区间 -0.04 至 1.23，p=0.066；I=94.1%，p<0.001）。与没有并发症的 SSc 患者相比，间质性肺病（ILD）患者的 NLR 显著更高（SMD=0.31，95%置信区间 0.15 至 0.46，p<0.001；I=43.9%，p=0.11），肺动脉高压（PAH，SMD=1.59，95%置信区间 0.04 至 3.1，p=0.045；I=87.6%，p<0.001）和手指溃疡（DU，SMD=0.43，95%置信区间 0.13 至 0.74，p=0.006；I=0.0%，p=0.49）。ILD 患者的 PLR 显著更高（SMD=0.42，95%置信区间 0.25 至 0.59，p<0.001；I=24.8%，p=0.26）。PAH 患者的 MLR 显著更高（SMD=0.63，95%置信区间 0.17 至 1.08，p=0.007；I=66.0%，p=0.086），ILD 患者的 MLR 呈升高趋势（SMD=0.60，95%置信区间 -0.04 至 1.23，p=0.066；I=94.1%，p<0.001）。
在适当设计的前瞻性研究结果出来之前，本系统评价和荟萃分析的结果表明，炎症的血液细胞衍生指标，特别是 NLR 和 PLR，可能有助于 SSc 的诊断和特定并发症的诊断。
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42024520040。
