Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
Clin Exp Med. 2024 Sep 4;24(1):207. doi: 10.1007/s10238-024-01478-x.
Existing challenges with the early diagnosis of rheumatoid arthritis (RA) and active disease, mainly by non-rheumatologists, have prompted the search for novel biomarkers. Elevations in indices derived from blood cell counts, e.g., the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been reported in RA patients. However, their diagnostic accuracy has not been comprehensively assessed. Therefore, we conducted a systematic review and meta-analysis of studies reporting the sensitivity and specificity of the NLR and PLR, obtained by receiver operating characteristic (ROC) curve analysis, for the presence of RA and active disease. We searched electronic databases from inception to 15 March 2024 and assessed the risk of bias using the JBI Critical Appraisal Checklist (PROSPERO registration number: CRD42024533546). In 15 studies, the NLR exhibited acceptable accuracy for the presence of RA (area under the curve, AUC = 0.76, 95% CI 0.72 to 0.80) and active disease (AUC = 0.70, 95% CI 0.66 to 0.74). The PLR exhibited good accuracy for the presence of RA (AUC = 0.80, 95% CI 0.76 to 0.83). There were insufficient studies to assess the accuracy of the PLR for the presence of active disease. Our systematic review and meta-analysis suggests that the NLR and the PLR are promising biomarkers of RA (NLR and PLR) and active disease (NLR). Further research is required to investigate whether the NLR and PLR can significantly enhance the capacity to diagnose RA and active disease in clinical practice.
现有的类风湿关节炎 (RA) 早期诊断和活动期疾病诊断挑战，主要由非风湿病学家提出，促使人们寻找新的生物标志物。已有研究报道，RA 患者的血细胞计数指标升高，例如中性粒细胞与淋巴细胞比值 (NLR) 和血小板与淋巴细胞比值 (PLR)。然而，其诊断准确性尚未得到全面评估。因此，我们对报道 NLR 和 PLR 通过受试者工作特征 (ROC) 曲线分析对 RA 和活动期疾病存在的敏感性和特异性的研究进行了系统评价和荟萃分析。我们从建立数据库到 2024 年 3 月 15 日检索了电子数据库，并使用 JBI 批判性评价清单 (PROSPERO 注册号：CRD42024533546) 评估了偏倚风险。在 15 项研究中，NLR 对 RA 的存在具有可接受的准确性 (曲线下面积，AUC=0.76，95%CI 0.72 至 0.80) 和活动期疾病 (AUC=0.70，95%CI 0.66 至 0.74)。PLR 对 RA 的存在具有良好的准确性 (AUC=0.80，95%CI 0.76 至 0.83)。评估 PLR 对活动期疾病存在的准确性的研究不足。我们的系统评价和荟萃分析表明，NLR 和 PLR 是 RA (NLR 和 PLR) 和活动期疾病的有前途的生物标志物。需要进一步研究以探讨 NLR 和 PLR 是否可以显著提高在临床实践中诊断 RA 和活动期疾病的能力。
