A study on the correlation between platelets/lymphocytes and hematological response in patients with severe aplastic anemia
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摘要: 目的 分析血小板/淋巴细胞比值(PLR)与重型再生障碍性贫血(SAA)患者血液学反应(HR)的关联性。方法 纳入2020年1月—2022年5月医院收治的137例SAA患者进行前瞻性随机队列研究，所有患者均在入院时检测血小板和淋巴细胞计数，计算PLR并依据其中位值2.44分为高PLR组(n=82)与低PLR组(n=55)。2组均给予环孢素+达那唑治疗6个月，比较2组治疗前及治疗6个月的临床特征及HR获得情况，并分析入院时PLR与SAA免疫抑制治疗患者HR的关联性。结果 低PLR组入院时血小板及治疗6个月白细胞、网织红细胞、中性粒细胞、血红蛋白、血小板均低于高PLR组，治疗6个月淋巴细胞水平高于高PLR组，差异有统计学意义(P < 0.05)；低PLR组HR获得率低于高PLR组，差异有统计学意义(P < 0.05)；未获得HR的SAA患者入院血小板、PLR低于获得HR组，入院时淋巴细胞高于获得HR组，差异有统计学意义(P < 0.05)；绘制受试者工作特征曲线，结果显示，入院时血小板、淋巴细胞、PLR对SAA免疫抑制治疗患者HR预测ROC曲线下面积均>0.7，且入院时PLR预测效能最好。结论 入院时PLR低会影响SAA免疫抑制患者HR获得情况，且入院时PLR对SAA免疫抑制患者HR预测效能较好，可作为SAA免疫抑制治疗患者疗效监测指标。Abstract: Objective To analyze the correlation between platelet/lymphocyte ratio(PLR) and hematological response(HR) in the patients with severe aplastic anemia(SAA).Methods A total of 137 SAA patients admitted to hospital from January 2020 to May 2022 were enrolled in a prospective randomized cohort study. All patients were tested for platelet and lymphocyte counts at admission, calculated PLR, and divided into high PLR group(n=82) and low PLR group(n=55) according to the median value of 2.44. Both groups were treated with cyclosporine+danazol for 6 months. The clinical characteristics and HR acquisition of the two groups before and after treatment for 6 months were compared, and the correlation between PLR and HR of SAA immunosuppressive patients at admission was analyzed.Results The platelet, leucocyte, reticulocyte, neutrophil, hemoglobin and platelet in the low PLR group were lower than those in the high PLR group at the time of admission, and the lymphocyte level in the low PLR group was higher than that in the high PLR group after 6 months of treatment, the difference was statistically significant(P < 0.05). The HR acquisition rate in the low PLR group was lower than that in the high PLR group, and the difference was statistically significant(P < 0.05). The platelet and PLR of SAA patients without HR were lower than those with HR, and the lymphocytes at admission were higher than those with HR, the difference was statistically significant(P < 0.05). The receiver operating characteristic curve(ROC) of the subjects was drawn, and the results showed that the area under the ROC curve(AUC) of platelet, lymphocytes, and PLR at admission for HR prediction in patients with SAA immunosuppressive therapy was>0.7, and the predictive efficacy of PLR at admission was the best.Conclusion Low PLR at admission will affect the HR acquisition of SAA immunosuppressive patients, and PLR at admission can predict the HR of SAA immunosuppressive patients better, which can be used as a monitoring index for the efficacy of SAA immunosuppressive patients.
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表 1 2组基线资料及实验室指标比较
项目 高PLR组(n=82) 低PLR组(n=55) 统计值 P 性别/例(%) χ2=0.148 0.701 男 43(52.44) 27(49.09) 女 39(47.56) 28(50.91) 年龄/岁 66.65±6.38 66.49±7.22 t=0.133 0.895 发病至免疫抑制治疗时间/月 4.91±1.09 4.82±1.00 t=0.510 0.611 收缩压/mmHg 112.05±10.93 109.85±9.74 t=1.234 0.219 舒张压/mmHg 81.18±7.58 81.30±7.73 t=0.092 0.927 高血压/例(%) χ2=0.156 0.692 是 28(34.15) 17(30.91) 否 54(65.85) 38(69.09) 糖尿病/例(%) χ2=0.062 0.803 是 15(18.29) 11(20.00) 否 67(81.71) 44(80.00) 高脂血症/例(%) χ2=0.071 0.790 是 7(8.54) 4(7.27) 否 75(91.46) 51(92.73) 入院时白细胞/(×109/L) 1.85±0.17 1.88±0.19 t=1.236 0.219 治疗6个月白细胞/(×109/L) 3.27±0.96 2.79±0.85 t=3.017 0.003 入院时网织红细胞/(×109/L) 15.77±2.63 15.73±2.59 t=0.090 0.928 治疗6个月网织红细胞/(×109/L) 21.74±4.10 18.55±3.63 t=4.681 < 0.001 入院时中性粒细胞/(×109/L) 0.37±0.07 0.39±0.09 t=1.369 0.174 治疗6个月中性粒细胞/(×109/L) 0.94±0.27 0.51±0.12 t=12.718 < 0.001 入院时HGB/(g/L) 70.96±6.38 71.02±6.42 t=0.049 0.961 治疗6个月HGB/(g/L) 90.26±8.55 82.67±7.62 t=5.311 < 0.001 入院时血小板/(×109/L) 14.02±1.96 12.76±2.27 t=3.466 0.001 治疗6个月血小板/(×109/L) 84.94±10.11 75.38±8.64 t=5.743 < 0.001 入院时淋巴细胞/(×109/L) 5.62±1.11 5.84±0.96 t=1.172 0.243 治疗6个月淋巴细胞/(×109/L) 3.58±0.84 4.60±0.95 t=6.672 < 0.001 
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表 2 2组HR获得情况比较
例(%) 项目 高PLR组(n=82) 低PLR组(n=55) 统计值 P HR获得 69(84.15) 29(52.73) χ2=15.959 < 0.001 CR 11(13.41) 2(3.64) Z=4.032 < 0.001 PR 25(30.49) 9(16.36) GPR 33(40.24) 18(32.73) NR 13(15.85) 26(47.27)
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表 3 2组基线资料及实验室指标比较
项目 获得HR组(n=98) 未获得HR组(n=39) 统计值 P 性别/例(%) χ2=0.001 0.978 男 50(51.02) 20(51.28) 女 48(48.98) 19(48.72) 年龄/岁 66.54±6.54 66.69±7.18 t=0.119 0.906 发病至免疫抑制治疗时间/月 4.80±0.97 5.00±1.17 t=1.044 0.298 收缩压/mmHg 110.89±10.28 110.36±10.31 t=0.271 0.786 舒张压/mmHg 81.78±7.60 79.95±7.68 t=1.266 0.208 高血压/例(%) χ2=0.006 0.939 是 32(32.65) 13(33.33) 否 66(67.35) 26(66.67) 糖尿病/例(%) χ2=0.038 0.846 是 19(19.39) 7(17.95) 否 79(80.61) 32(82.05) 高脂血症/例(%) χ2=0.003 0.955a 是 8(8.16) 4(10.26) 否 90(91.84) 35(89.74) 入院时白细胞/(×109/L) 1.85±0.18 1.88±0.18 t=0.990 0.324 入院时网织红细胞/(×109/L) 15.48±2.44 16.44±2.91 t=1.958 0.052 入院时中性粒细胞/(×109/L) 0.38±0.08 0.38±0.09 t=0.039 0.969 入院时HGB/(g/L) 71.10±6.40 70.69±6.36 t=0.339 0.735 入院时血小板计数/(×109/L) 14.11±1.82 12.03±2.29 t=5.622 < 0.001 入院时淋巴细胞/(×109/L) 5.45±0.99 6.36±0.93 t=4.951 < 0.001 入院时PLR 2.59±0.91 1.89±0.69 t=6.078 < 0.001 a采用连续性修正检验。
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表 4 入院PLR对SAA免疫抑制治疗患者HR的预测效能分析
项目 AUC AUC的95%CI 标准误 P 最佳阈值 灵敏度 特异度 约登指数 入院时血小板计数 0.746 0.652~0.840 0.048 < 0.001 13.500×109/L 0.744 0.622 0.366 入院时淋巴细胞 0.733 0.642~0.824 0.046 < 0.001 5.500×109/L 0.436 0.878 0.314 入院时PLR 0.767 0.688~0.846 0.040 < 0.001 2.325 0.872 0.622 0.494
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