摘要
目的 拟评估中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、系统性免疫炎症指数(SII)在反映司库奇尤单抗(SEC)治疗银屑病关节炎(PsA)疗效中的价值.方法 纳入北京大学第一医院PsA随访队列(PKUPsA队列)中于2019年1月至2023年3月期间接受SEC治疗的49例患者,回顾其基线及SEC治疗6个月及12个月后的各项指标.采用配对t检验或配对样本Wilcoxon符号秩和检验比较治疗前后炎症指标的变化情况,通过Spearman相关性分析探究NLR、PLR、SII与其他临床及实验室指标的相关性,Cox比例风险模型分析治疗12个月期间患者达最小疾病活动度(MDA)的预测因素.结果 经 SEC 治疗 6 个月后,患者 PLR(142±62 与 164±61,t=2.55,P=0.016,n=31)、SII(553±428 与725±361,t=2.28,P=0.030,n=31)较基线时下降;治疗12个月后患者SII较基线仍有显著下降(613±407与792±365,t=2.33,P=0.028,n=26).经SEC治疗6个月及12个月后,患者的ESR、CRP、银屑病关节炎疾病活动指数(DAPSA)评分较基线时的下降也均具有统计学意义.NLR、PLR、SII与ESR和CRP的基线水平及治疗期间变化量之间均存在稳定的正相关性(r=0.29～0.61,P均＜0.05).无论是基线时还是治疗过程中,NLR、SII 与压痛关节数(r=0.34～0.63,P均＜0.05)、DAPSA 评分(r=0.30～0.68,P均＜0.05)之间,SII 与疼痛视觉模拟评分(VAS)(r=0.39～0.56,P＜0.01)、患者总体评分(PtGA)(r=0.33～0.62,P＜0.05)之间均存在稳定的正相关.此外,NLR、PLR、SII与焦虑障碍量表(GAD-7)评分、患者健康问卷(PHQ-9)评分的基线水平和治疗12个月后的变化量之间也呈现不同程度的正相关性(r=0.33～0.78,P＜0.05;r=0.37～0.58,P＜0.05).Cox比例风险模型分析显示较高的基线PLR及DAPSA评分是治疗12个月内达到MDA的不利因素,但仅DAPSA 评分是独立的预测因素[HR值(95％CI)=0.87(0.78,0.97),P=0.010].结论 NLR、PLR、SII 能够反映PsA患者在SEC治疗期间疾病活动度及焦虑、抑郁情绪的变化,然而基线NLR、PLR、SII均不能预测SEC治疗12个月内患者MDA的达标情况.
Abstract
Objective To evaluate the value of neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and systemic immune-inflammation index(SII)in reflecting the effectiveness of secukinumab(SEC)in psoriatic arthritis(PsA).Methods Forty-nine patients treated with SEC betwee January 2019 and March 2023 from the PsA cohort(PKUPsA cohort)were enrolled.Demographic data and disease activity indexes,laboratory markers including NLR,PLR,SII,patient-reported outcome measures at baseline,6 months and 12 months after SEC treatment were retrospectively analyzed.Paired-sample t test and Wilcoxon signed-rank test were used to compare the changes of inflammatory markers before and after the treatment,Spearman correlation analysis was used to explore the correlation between NLR,PLR,SII and other clinical and laboratory indicators,and Cox proportional hazards model was used to analyze the predictive factors of achieving minimal disease activity(MDA)during 12 months of SEC treatment.Results After 6 months of SEC treatment,PLR and SII decreased significantly from the baseline(142±62 vs.164±61,t=2.55,P=0.016,n=31;553±428 vs.725±361,t=2.28,P=0.030,n=31);After 12 months of treatment,SII also showed a statistically significant decline from the baseline(613±407 vs.792±365,t=2.33,P=0.028,n=26).Patients'C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and disease activity index for psoriatic arthritis(DAPSA)score at the 6th and the 12th month of SEC treatment were significantly lower than baseline as well.In terms of the correlation between NLR,PLR,SII and other indicators,there was a stable positive correlations between the baseline level and the changes over 6-month and 12-month after SEC treatment in NLR,PLR,SII,CRP and ESR(r=0.29～0.61,P＜0.05).Similarly,NLR,SII at baseline and the changes at month 6 and month 12 from baseline showed positive associations consistently with tenderness joint counts(r=0.34～0.63,P＜0.05)and DAPSA score(r=0.30～0.68,P＜0.05).Stable positive correlations of SII with visual analogue scale(VAS)of pain(r=0.39～0.56,P＜0.01)and patient global assessment(PtGA)(r=0.33～0.62,P＜0.05)were also observed.In addition,there was also positive correlation of NLR,PLR and SII with the generalized anxiety disorder scale(GAD-7)and patient health questionnaire-9(PHQ-9)score at baseline and 12-month after SEC treatment(r=0.33～0.78,P＜0.05;r=0.37～0.58,P＜0.05).Cox proportional hazards model showed that baseline PLR and DAPSA score were adverse factors for achieving MDA during 12 months of treatment,however,baseline DAPSA score was the only independent predictor[HR(95％CI)=0.87(0.78,0.97),P=0.010].Conclusion NLR,PLR,and SII can be used as biomarkers for monitoring the improvement in disease activity,anxiety and depression levels of patients with PsA,but baseline NLR,PLR,and SII cannot predict the achievement of MDA at 12 months after SEC treatment.
基金项目
白求恩公益基金会"免疫炎症性疾病科研支持"项目(J202301E036)
北京大学第一医院青年临床研究专项基金课题(2019CR28)
北京大学第一医院交叉临床研究专项(2021CR30)
NETL
NSTL
万方数据