探讨外周血细胞计数比值在类风湿关节炎(RA)患者病情活动和疗效评估中的价值。

回顾性分析2019年10月至2020年10月宿迁市第一人民医院收治的符合RA诊断标准且未接受过相关治疗116例RA患者的临床资料为观察组，排除心肝肾功能不全、合并血液或免疫系统疾病、恶性肿瘤者；另选择同期健康体检者96例为对照组。计算中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)。观察组患者依据28个关节疾病活动评分(DAS28)分为缓解组和活动组；活动组患者再依据治疗后疗效分为有效组和无效组。多组间比较采用方差分析，两组间比较采用独立样本t检验。采用logistic回归分析临床资料确定RA病情活动的影响因素，并分析NLR、PLR、LMR与病情活动的相关性及治疗前后的变化差异。利用受试者工作特征曲线(ROC)及曲线下面积(AUC)评估NLR、PLR、LMR对RA病情活动及疗效的预测价值。

根据DAS28评分缓解组为32例和活动组84例；活动组患者NLR、PLR水平均高于缓解组，LMR水平低于缓解组，差异均有统计学意义(t＝3.957、6.336、3.696，均为P<0.001)。NLR、PLR、LMR对RA患者病情活动的曲线下面积(AUC)分别为0.835、0.810、0.812，敏感度分别为88.9%、69.1%、67.9%，特异度分别为74.3%、77.1%、85.7%。活动组患者依据疗效有效组有53例，无效组31例。有效组NLR、PLR值均低于无效组，LMR值均高于无效组，差异均有统计学意义(t＝3.493、4.536、3.742，均为P<0.01)。NLR、PLR、LMR对RA患者治疗效果的AUC分别为0.777、0.749、0.783，敏感度分别为65.6%、59.4%、65.7%，特异度分别为85.7%、85.7%、77.5%。

NLR、PLR、LMR是RA患者的病情活动的独立影响因素，对于评估病情活动及疗效具有较好价值，有效而简便，可作为临床中长期监测RA病情的参考指标。

To investigate the value of peripheral blood cell count ratio in evaluating disease activity and efficacy in patients with rheumatoid arthritis (RA).

The clinical data of 116 patients with RA who met the diagnostic criteria and did not receive relevant treatment in the First People's Hospital of Suqian City from October 2019 to October 2020 were retrospectively analyzed as the observation group, cardiac or hepatic-renal insuffiencies, hematological or immune system diseases, and malignant tumors were excluded; 96 healthy volunteers were selected as the control group at the same time. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio (LMR) were calculated. According to the 28 joint disease activity score (DAS28), patients were divided into the remission group and active group; then the patients in remission group were divided into effective group and invalid group according to the therapeutic effects after treatment. Variance analysis was used for comparison between multiple groups, and independent sample t test was used for comparison between two groups. Logistic regression was used to analyze clinical data to determine the influencing factors of RA disease activity, and the correlation between NLR, PLR, LMR and disease activity and the changes before and after treatment were analyzed. Receiver operating characteristic curve (ROC) and area under curve(AUC) of it was used to evaluate the predictive value of NLR, PLR and LMR in RA disease activity and outcomes.

According DAS28, 32 patients were in remission group and 84 were in active group. The levels of NLR and PLR in active group were higher than those in remission group, while the levels of LMR were lower than those in remission group, with statistically significant differences (t=3.957, 6.336, 3.696, all P<0.001). The AUC of NLR, PLR and LMR for disease activity in RA patients were 0.835, 0.810 and 0.812, respectively. The sensitivities were 88.9%, 69.1% and 67.9%, and the specificities were 74.3%, 77.1% and 85.7%, respectively. According to therapeutic effects, 53 patients were in effective group and 31 were in invalid group. The NLR and PLR values of the effective group were lower than those of the ineffective group, and the LMR values were higher than those of the ineffective group, with statistical significance (t=3.493, 4.536, 3.742, all P<0.01). The AUC of NLR, PLR and LMR for RA patients was 0.777, 0.749 and 0.783 respectively; the sensitivity was 65.6%, 59.4% and 65.7%, and the specificity was 85.7%, 85.7% and 77.5%, respectively.

NLR, PLR and LMR are independent influencing factors of disease activity in patients with RA. They are effective and simple in evaluating disease activity and efficacy, and can be used as reference index for long-term clinical monitoring of RA disease.