Masoumi Maryam, Bozorgi Maryam, Nourmohammadi Zahra, Mousavi Mohammad Javad, Shariati Aref, Karami Jafar
Clinical Research and Development Unit, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran.
Student Research committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran.
BMC Rheumatol. 2024 Dec 26;8(1):75. doi: 10.1186/s41927-024-00444-0.
Reducing inflammation is central to the management of RA. However, commonly used markers such as CRP and ESR, along with the DAS-28 score, have shown limitations. Hematologic indices, such as platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR), show potential as reliable indicators of inflammation in RA. This study evaluates these markers across different RA activity levels to identify effective biomarkers for distinguishing active RA from remission.
305 RA patients were enrolled in our study, diagnosed by ACR/EULAR 2010 criteria, and divided into four groups according to the DAS28-ESR score. 8 ml of blood were taken for a CBC test and serological tests such as rheumatoid factor (RF), anticyclic citrullinated peptide antibodies (anti-CCP), anti-nuclear antibodies (ANA), and C-reactive protein (CRP). Platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) were assessed as potential markers of inflammation.
The mean age of RA patients was 51.7 years and a disease duration of 56.7 months. Significant differences in tender and swollen joints were observed between RA groups. Laboratory findings revealed higher CRP and ESR in active RA patients, while hemoglobin, hematocrit, and lymphocyte counts were higher in remission group. ROC analysis showed ESR, CRP, NLR, and PLR as potential markers for distinguishing active from remission RA, with ESR demonstrating the highest diagnostic accuracy. LMR could not differentiate between active and inactive forms of RA disease.
The NLR and PLR markers were significantly correlated with traditional inflammatory markers like CRP and ESR. These novel markers could be useful tools for evaluating RA activity, offering a cost-effective alternative to imaging techniques. Further research is needed to confirm their clinical utility.
减轻炎症是类风湿关节炎（RA）管理的核心。然而，常用的标志物如C反应蛋白（CRP）、红细胞沉降率（ESR）以及疾病活动评分28（DAS-28）已显示出局限性。血液学指标，如血小板淋巴细胞比值（PLR）、淋巴细胞单核细胞比值（LMR）和中性粒细胞淋巴细胞比值（NLR），显示出作为RA炎症可靠指标的潜力。本研究评估这些标志物在不同RA活动水平中的表现，以确定区分活动期RA与缓解期的有效生物标志物。
305例RA患者纳入本研究，根据美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）2010标准进行诊断，并根据DAS28-ESR评分分为四组。采集8毫升血液进行全血细胞计数（CBC）检测以及类风湿因子（RF）、抗环瓜氨酸肽抗体（抗CCP）、抗核抗体（ANA）和C反应蛋白（CRP）等血清学检测。评估血小板淋巴细胞比值（PLR）、淋巴细胞单核细胞比值（LMR）和中性粒细胞淋巴细胞比值（NLR）作为炎症的潜在标志物。
RA患者的平均年龄为51.7岁，病程为56.7个月。RA各组间压痛和肿胀关节存在显著差异。实验室检查结果显示，活动期RA患者的CRP和ESR较高，而缓解组的血红蛋白、血细胞比容和淋巴细胞计数较高。受试者工作特征（ROC）分析显示，ESR、CRP、NLR和PLR是区分活动期与缓解期RA的潜在标志物，其中ESR的诊断准确性最高。LMR无法区分RA疾病的活动期和非活动期。
NLR和PLR标志物与CRP和ESR等传统炎症标志物显著相关。这些新型标志物可能是评估RA活动的有用工具，为成像技术提供了一种经济有效的替代方法。需要进一步研究以证实它们的临床实用性。
