Yang Xiaolan
Department of Clinical Laboratory, Chengdu Wuhou Huanya Huakang Medical Examination Center, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2025 Jul 18;104(29):e43048. doi: 10.1097/MD.0000000000043048.
To investigate the supplementary value of the neutrophil-to-lymphocyte ratio (NLR) in diagnosing rheumatoid arthritis (RA) and assessing disease activity, particularly in seronegative RA. This retrospective single-center study included 304 patients from the Department of Rheumatology and Immunology at a tertiary hospital between February 2021 and February 2024. The RA group consisted of 201 patients, and the non-RA control group had 103 patients. Demographic characteristics, blood tests, inflammatory markers (C-reactive protein, erythrocyte sedimentation rate), autoantibodies (rheumatoid factor, anti-cyclic citrullinated peptide antibody), and clinical evaluation data (Disease Activity Score in 28 Joints score) were collected. Multivariate logistic and ordinal logistic regression analyses were performed to identify RA-related factors. The combined diagnostic benefit of NLR was assessed using area under the receiver operating characteristic curve (AUC), net reclassification improvement, and integrated discrimination improvement. Among the 304 subjects, 201 were RA patients (mean age 52.3 ± 11.8 yr, 78.6% female) and 103 were non-RA controls (mean age 50.6 ± 10.2 yr, 73.8% female). The NLR in the RA group was significantly higher than in the non-RA group (3.2 [2.1-4.8] vs 1.8 [1.2-2.3], P < .001). Multivariate regression analysis showed that NLR was an independent predictor for RA diagnosis (odds ratio = 2.15, 95% confidence interval: 1.62-2.85, P < .001), with better diagnostic performance than C-reactive protein and erythrocyte sedimentation rate. In seronegative RA patients, NLR remained significantly diagnostic (odds ratio = 2.01, 95% confidence interval: 1.20-3.37, P = .008). NLR positively correlated with disease activity and was higher in moderate-to-high activity patients (4.2 [3.2-5.5], P < .001). Incremental analysis showed that NLR improved model performance: in the RA population, AUC increased from 0.89 to 0.94 (ΔAUC = 0.05, P < .001), and in seronegative RA, AUC increased from 0.72 to 0.82 (P = .002). For disease activity prediction, AUC increased from 0.85 to 0.91 (ΔAUC = 0.06, P = .004), with significant improvements in net reclassification improvement and integrated discrimination improvement (0.18 and 0.07, respectively). NLR is an independent predictor for diagnosing RA and assessing disease activity, particularly in seronegative RA. It enhances diagnostic sensitivity and model discriminative ability and should be promoted as a key inflammatory biomarker for early RA diagnosis.
为研究中性粒细胞与淋巴细胞比值（NLR）在类风湿关节炎（RA）诊断及疾病活动度评估中的补充价值，尤其是在血清阴性RA中的价值。这项回顾性单中心研究纳入了2021年2月至2024年2月期间一家三级医院风湿免疫科的304例患者。RA组有201例患者，非RA对照组有103例患者。收集了人口统计学特征、血液检查、炎症标志物（C反应蛋白、红细胞沉降率）、自身抗体（类风湿因子、抗环瓜氨酸肽抗体）及临床评估数据（28个关节疾病活动评分）。进行多因素逻辑回归和有序逻辑回归分析以确定RA相关因素。使用受试者工作特征曲线下面积（AUC）、净重新分类改善和综合判别改善来评估NLR的联合诊断效益。在304名受试者中，201例为RA患者（平均年龄52.3±11.8岁，78.6%为女性），103例为非RA对照组（平均年龄50.6±10.2岁，73.8%为女性）。RA组的NLR显著高于非RA组（3.2[2.1 - 4.8]对1.8[1.2 - 2.3]，P <.001）。多因素回归分析显示，NLR是RA诊断的独立预测因素（比值比 = 2.15，95%置信区间：1.62 - 2.85，P <.001），诊断性能优于C反应蛋白和红细胞沉降率。在血清阴性RA患者中，NLR仍具有显著诊断价值（比值比 = 2.01，95%置信区间：1.20 - 3.37，P =.008）。NLR与疾病活动度呈正相关，在中度至高度活动患者中更高（4.2[3.2 - 5.5]，P <.001）。增量分析表明，NLR改善了模型性能：在RA人群中，AUC从0.89增加到0.94（ΔAUC = 0.05，P <.001），在血清阴性RA中，AUC从0.72增加到0.82（P =.002）。对于疾病活动度预测，AUC从0.85增加到0.91（ΔAUC = 0.06，P =.004），净重新分类改善和综合判别改善有显著提高（分别为0.18和0.07）。NLR是诊断RA及评估疾病活动度的独立预测因素，尤其是在血清阴性RA中。它提高了诊断敏感性和模型判别能力，应作为早期RA诊断的关键炎症生物标志物加以推广。
