NLR、PLR、MLR、MPV在评估痛风性关节炎疾病活动度中的临床价值

The Clinical Value of NLR, PLR, MLR and MPV in Evaluating Gout Disease Activity

摘要: 目的：探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、平均血小板体积(MPV)与痛风性关节炎病情活动度的关系及其临床价值。方法：选取2022年10月至2023年10月我院风湿免疫科门诊和住院的94例痛风性关节炎患者，根据GAS评分分为病情活动组(24人)及病情缓解组(70人)，同时将94例健康人作为健康对照组。比较各组的NLR、PLR、MLR、MPV与GAS、BUA、CRP、ESR等指标，采用Spearman线性相关分析NLR、PLR、MLR、MPV与各活动指标之间的相关性，绘制ROC曲线评估以上四种指标在痛风活动度中的价值。结果：1、痛风性关节炎两组患者MPV、NLR、MLR、BUA、CRP、ESR、关节疼痛个数、痛风石数、发作次数、VAS评分、GAS评分均高于健康组；痛风性关节炎病情活动组MPV、NLR、MLR、PLR、BUA、CRP、关节疼痛个数、痛风石数、VAS评分、GAS评分均高于痛风性关节炎病情缓解组；痛风性关节炎缓解组MPV、NLR、MLR、CRP、ESR均高于健康对照组，PLR、BUA则低于健康对照组；(均P < 0.05)。2、病情活动组PLR与BUA、CRP、ESR、GAS评分均呈正相关，(rPLR = 0.386、0.562、0.0275、0.377，均P < 0.05)；NLR与BUA、CRP、GAS呈正相关，(r_NLR = 0.34、0.52、0.353，均P < 0.05)；MLR与CRP呈正相关，(r_MLR = 0.385, P < 0.05)；MPV与BUA、GAS、CRP评分呈正相关，(r_PMV = 0.383、0.285、0.34，均P<0.05)。3、二元logistic回归分析结果提示NLR、PLR、MPV、CRP为痛风性关节炎的危险因素，(β_NLR = 1.603、β_PLR = 0.045、β_MPV = 1.446、β_CRP = 0.099，均P < 0.05)；4、NLR、PLR、MPV、CRP及四者联合评估痛风性关节炎疾病活动度的曲线下面积(AUC)分别为0.876、0.896、0.784、0.935、0.985，灵敏度分别为84.3%、78.6%、71.4%、84.3%、98.6%，特异度分别为91.7%、91.7%、79.2%、95.8%、91.7%。结论：在痛风性关节炎患者中NLR、PLR、MLR、MPV与病情活动度密切相关，且为痛风性关节炎的独立危险因素，可作为临床诊断及预测痛风性关节炎疾病活动度的辅助指标。

Abstract: Objective: To investigate the relationship between neutrophil-lymphocyte ratio (NLR), plate-let-to-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), mean platelet volume (MPV) and the disease activity of gouty arthritis and its clinical value. Methods: A total of 94 outpatients and inpatients with gouty arthritis in the Department of Rheumatology and Immunology of our hospital from October 2022 to October 2023 were enrolled and divided into an active disease group (24 cases) and a remission group (70 cases) according to the GAS score, and 94 healthy people were selected as the healthy control group. The NLR, PLR, MLR, MPV and GAS, BUA, CRP, ESR and other indicators of each group were compared. Spearman linear correlation analysis was used to analyze the correlation between NLR, PLR, MLR, MPV and each activity index, and ROC curve was drawn to evaluate the value of the above four indicators in gout activity. Results: 1. MPV, NLR, MLR, BUA, CRP, ESR, the number of joint pain, the number of tophi, the number of attacks, VAS score and GAS score of the two gouty arthritis groups were higher than those of the healthy group. MPV, NLR, MLR, PLR, BUA, CRP, number of joint pain, number of tophi, VAS score and GAS score in active gouty arthritis group were higher than those in remission gouty arthritis group. MPV, NLR, MLR, CRP and ESR in remission gouty arthritis group were higher than those in healthy control group, PLR and BUA were lower than those in healthy control group. (all P < 0.05). 2. PLR was positively correlated with BUA, CRP, ESR and GAS scores in the disease activity group (r_PLR = 0.386, 0.562, 0.0275, 0.377, all P < 0.05). NLR was positively correlated with BUA, CRP and GAS (r_NLR = 0.34, 0.52, 0.353, all P < 0.05). MLR was positively correlated with CRP (r_MLR = 0.385, P < 0.05). MPV was positively correlated with BUA, GAS and CRP scores (r_PMV = 0.383, 0.285, 0.34, all P < 0.05). 3. Binary logistic regression analysis showed that NLR, PLR, MPV and CRP were risk factors for gouty arthritis (β_NLR = 1.603, β_PLR = 0.045, β_MPV = 1.446, β_CRP = 0.099, all P < 0.05). The area under the curve (AUC) of NLR, PLR, MPV, CRP and the combination of the four to evaluate the disease activity of gouty arthritis was 0.876, 0.896, 0.784, 0.935 and 0.985, respectively, and the sensitivity was 84.3%, 78.6%, 71.4%, 84.3% and 98.6%, respectively. The specificity were 91.7%, 91.7%, 79.2%, 95.8% and 91.7%, respectively. Conclusion: NLR, PLR, MLR and MPV are closely related to the disease activity of gouty arthritis, and are independent risk factors for gouty arthritis. They can be used as auxiliary indicators for clinical diagnosis and prediction of gouty arthritis.