Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China.
Department of Rheumatology and Immunology, Beijing Hospital, Beijing, China.
Ann Med. 2024 Dec;56(1):2346546. doi: 10.1080/07853890.2024.2346546. Epub 2024 Jun 7.
Although normal acute phase reactants (APRs) play an important role in assessing disease activity of rheumatoid arthritis (RA), some studies pointed out the discordance between disease activity and APR level. Neutrophil-to-lymphocyte ratios (NLRs), platelet-to-lymphocyte ratios (PLRs) and lymphocyte-to-monocyte ratios (LMRs) have been reported to be sensitive measures of inflammatory reaction. This study aims to explore the value of these haematological makers in assessment of APR-negative RA patients.
Out of a cohort of 418 consecutive patients with RA, we enrolled 135 patients with normal APR for this study. We performed ultrasound assessments to evaluate synovitis and bone erosion in the affected joints. Synovitis was evaluated by ultrasound grey scale (GS) and power Doppler (PD) with semi-quantitative scoring (0-3). Demographic, clinical and laboratory data were collected from the patients. Disease Activity Score-28 joints (DAS28), NLR, MLR and PLR were calculated.
In RA patients with normal APR, PLR exhibited a positive correlation with ultrasound-detected synovitis and bone erosion, whereas NLR, MLR showed no significant correlation with ultrasonography parameters. The area under the ROC curve (AUC) for identifying synovitis with a GS grade ≥2 based on a PLR cutoff value of ≥159.6 was 0.7868 (sensitivity: 80.95%, specificity: 74.24%). For synovitis with a PD grade ≥2, the AUC was 0.7690, using a PLR cutoff value of ≥166.1 (sensitivity: 68.0%, specificity: 83.87%).
Our findings suggested that PLR might be a reliable and cost-effective marker for identifying moderate-to-severe synovitis in RA patients with normal APR.
尽管正常的急性期反应物（APRs）在评估类风湿关节炎（RA）的疾病活动度方面起着重要作用，但一些研究指出疾病活动度与 APR 水平之间存在不一致性。中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和淋巴细胞与单核细胞比值（LMR）已被报道为炎症反应的敏感指标。本研究旨在探讨这些血液标志物在评估 APR 阴性 RA 患者中的价值。
在 418 例连续 RA 患者中，我们纳入了 135 例 APR 正常的患者进行本研究。我们对受影响关节进行超声评估，以评估滑膜炎和骨侵蚀。滑膜炎通过超声灰度（GS）和功率多普勒（PD）进行半定量评分（0-3）进行评估。收集患者的人口统计学、临床和实验室数据。计算疾病活动评分 28 个关节（DAS28）、NLR、MLR 和 PLR。
在 APR 正常的 RA 患者中，PLR 与超声检测到的滑膜炎和骨侵蚀呈正相关，而 NLR、MLR 与超声参数无显著相关性。基于 PLR 截断值≥159.6，用于识别 GS 分级≥2 的滑膜炎的 ROC 曲线下面积（AUC）为 0.7868（灵敏度：80.95%，特异性：74.24%）。对于 PD 分级≥2 的滑膜炎，AUC 为 0.7690，使用 PLR 截断值≥166.1（灵敏度：68.0%，特异性：83.87%）。
我们的研究结果表明，PLR 可能是识别 APR 正常的 RA 患者中中重度滑膜炎的可靠且具有成本效益的标志物。
