中性粒细胞与淋巴细胞比值、红细胞体积分布宽度与乙型肝炎及乙型肝炎肝硬化的关系研究(1)
摘要：目的 探討乙型肝炎患者外周血中性粒细胞和淋巴细胞计数、红细胞体积分布宽度(RDW)随着乙型肝炎病情进展而恶化时变化情况，以及中性粒细胞与淋巴细胞比值(NLR)、RDW与乙型肝炎、乙型肝炎肝硬化间的关系。方法 收集2016年8月～2018年7月安徽医科大学第三附属医院(合肥市第一人民医院)消化科、感染科、体检中心及南区(合肥市滨湖医院)感染科研究对象共162例，其中健康对照组50例，乙型肝炎组患者50例，乙型肝炎肝硬化组患者62例。检测三组血常规、肝功能指标、RDW，并计算NLR，分析三组间其相应值变化差异;对乙型肝炎肝硬化组患者利用Child-Pugh评分系统进行各自肝功能分级，分析NLR、RDW水平同Child-Pugh评分的相关性。绘制受试者工作特征(ROC)曲线检测NLR和RDW在乙型肝炎肝硬化组中的特异性、灵敏性、准确性。结果 ①三组白细胞计数、中性粒细胞计数、淋巴细胞计数、ALT、AST、TBIL、ALB、PT、NLR和RDW水平比较，差异有统计学意义(P<0.05);健康对照组的NLR和RDW与乙型肝炎组比较，差异无统计学意义(P>0.05);乙型肝炎肝硬化组的NLR和RDW均高于健康对照组和乙型肝炎组，差异具有统计学意义(P<0.05)。②在乙型肝炎肝硬化组中，随着肝脏炎症损伤程度加重，NLR水平呈显著上升趋势，RDW也呈现升高趋势。NLR、RDW水平同乙型肝炎肝硬化患者Child-Pugh评分呈正相关(P<0.05)。③利用ROC曲线分析显示，NLR、RDW诊断乙型肝炎肝硬化的AUC分别为0.687、0.816，差异均有统计学意义(P<0.05);当NLR、RDW的截点值为2.25、14.25，灵敏度分别为0.581、0.726，特异度分别为0.8、0.8。结论 NLR、RDW数值的变化与乙型肝炎、乙型肝炎肝硬化发展进程密切相关，其慢性肝炎发展为肝硬化，肝硬化进一步发展为失代偿期的过程会导致NLR、RDW水平也相应升高。NLR、RDW可归入到其Child-Pugh评分系统中，辅助预测乙型肝炎患者肝功能情况，评估肝脏纤维化程度，通过AUC来判定，相对于NLR来说，RDW准确性更高。
, 百拇医药
关键词：NLR;RDW;乙型肝炎;乙型肝炎肝硬化
中图分类号：R512.62 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.03.022
文章编号：1006-1959(2019)03-0069-06
Abstract：Objective To investigate the changes of peripheral blood neutrophil and lymphocyte count and erythrocyte volume distribution width (RDW) in patients with hepatitis B with the progression of hepatitis B， and the ratio of neutrophil to lymphocyte (NLR). The relationship between RDW and hepatitis B and hepatitis B cirrhosis. Methods From August 2016 to July 2018， 162 cases were collected from the third affiliated Hospital of Anhui Medical University (Hefei first people's Hospital)， Department of Digestive Diseases， Department of infection， physical examination Center and Southern District (Binhu Hospital of Hefei)， among which 50 cases were healthy control group. There were 50 cases in hepatitis B group and 62 cases in hepatitis B cirrhosis group. Blood routine examination， liver function index， RDW， and NLR， analysis were used to analyze the difference of the corresponding values among the three groups. The liver function of patients with hepatitis B cirrhosis was assessed by Child-Pugh scoring system， and the correlation between NLR，RDW level and Child-Pugh score was analyzed. The specificity， sensitivity and accuracy of NLR and RDW in patients with hepatitis B cirrhosis were determined by (ROC) curve.Results ①The white blood cell count， neutrophil count， lymphocyte count， ALT， AST， TBIL， ALB， PT， NLR and RDW levels of the three groups were statistically significant (P<0.05);There was no significant difference in NLR and RDW between the healthy control group and the hepatitis B group (P>0.05). The NLR and RDW of the hepatitis B cirrhosis group were higher than those of the healthy control group and the hepatitis B group，the difference was statistically significant (P<0.05).②In the hepatitis B cirrhosis group， with the severity of liver inflammation damage， NLR levels showed a significant upward trend， and RDW also showed an increasing trend. The levels of NLR and RDW were positively correlated with Child-Pugh score in patients with hepatitis B cirrhosis (P<0.05). ③Using ROC curve analysis， the AUC of NLR and RDW for diagnosis of hepatitis B cirrhosis were 0.687 and 0.816， respectively，the difference was statistically significant (P<0.05). When NLR and RDW had cutoff values of 2.25 and 14.25， sensitivity They were 0.581 and 0.726， respectively， and the specificities were 0.8 and 0.8， respectively. Conclusion The changes of NLR and RDW values are closely related to the development of hepatitis B and hepatitis B cirrhosis. The development of chronic hepatitis into cirrhosis and the further development of cirrhosis into decompensation will lead to a corresponding increase in NLR and RDW levels.NLR and RDW can be classified into their Child-Pugh scoring system to help predict liver function in patients with hepatitis B and to assess the degree of liver fibrosis. The AUC is used to determine the accuracy of RDW compared with NLR., 百拇医药(李安乐 戴夫 彭琼)
, 百拇医药
关键词：NLR;RDW;乙型肝炎;乙型肝炎肝硬化
中图分类号：R512.62 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.03.022
文章编号：1006-1959(2019)03-0069-06
Abstract：Objective To investigate the changes of peripheral blood neutrophil and lymphocyte count and erythrocyte volume distribution width (RDW) in patients with hepatitis B with the progression of hepatitis B， and the ratio of neutrophil to lymphocyte (NLR). The relationship between RDW and hepatitis B and hepatitis B cirrhosis. Methods From August 2016 to July 2018， 162 cases were collected from the third affiliated Hospital of Anhui Medical University (Hefei first people's Hospital)， Department of Digestive Diseases， Department of infection， physical examination Center and Southern District (Binhu Hospital of Hefei)， among which 50 cases were healthy control group. There were 50 cases in hepatitis B group and 62 cases in hepatitis B cirrhosis group. Blood routine examination， liver function index， RDW， and NLR， analysis were used to analyze the difference of the corresponding values among the three groups. The liver function of patients with hepatitis B cirrhosis was assessed by Child-Pugh scoring system， and the correlation between NLR，RDW level and Child-Pugh score was analyzed. The specificity， sensitivity and accuracy of NLR and RDW in patients with hepatitis B cirrhosis were determined by (ROC) curve.Results ①The white blood cell count， neutrophil count， lymphocyte count， ALT， AST， TBIL， ALB， PT， NLR and RDW levels of the three groups were statistically significant (P<0.05);There was no significant difference in NLR and RDW between the healthy control group and the hepatitis B group (P>0.05). The NLR and RDW of the hepatitis B cirrhosis group were higher than those of the healthy control group and the hepatitis B group，the difference was statistically significant (P<0.05).②In the hepatitis B cirrhosis group， with the severity of liver inflammation damage， NLR levels showed a significant upward trend， and RDW also showed an increasing trend. The levels of NLR and RDW were positively correlated with Child-Pugh score in patients with hepatitis B cirrhosis (P<0.05). ③Using ROC curve analysis， the AUC of NLR and RDW for diagnosis of hepatitis B cirrhosis were 0.687 and 0.816， respectively，the difference was statistically significant (P<0.05). When NLR and RDW had cutoff values of 2.25 and 14.25， sensitivity They were 0.581 and 0.726， respectively， and the specificities were 0.8 and 0.8， respectively. Conclusion The changes of NLR and RDW values are closely related to the development of hepatitis B and hepatitis B cirrhosis. The development of chronic hepatitis into cirrhosis and the further development of cirrhosis into decompensation will lead to a corresponding increase in NLR and RDW levels.NLR and RDW can be classified into their Child-Pugh scoring system to help predict liver function in patients with hepatitis B and to assess the degree of liver fibrosis. The AUC is used to determine the accuracy of RDW compared with NLR., 百拇医药(李安乐 戴夫 彭琼)