-
慢性鼻窦炎(chronic rhino sinusitis, CRS)是临床发生率较高的耳鼻咽喉头颈外科疾病,也属于一种慢性非特异性化脓性炎症疾病,可对病人日常生活及学习造成严重的影响[1]。目前临床针对保守治疗无明显疗效的CRS病人常采用鼻内镜手术进行治疗,可达到清除病灶组织、改善鼻窦通气状况等目的,但术后复发率较高,病情可变得更为严重,再次手术治疗的难度显著性增加[2]。因此需早期准确预测CRS病人鼻内镜术后复发的风险性,从而有助于改善病人的预后[3]。近些年研究[4]发现,外周血中性粒细胞数与淋巴细胞数比值(neutrophil-to- lymphocyte ratio, NLR)在CRS等较多炎性疾病中具有重要的诊断及预后判断价值。还有研究[5]证实,白细胞介素(interleukin, IL)-6在CRS伴鼻息肉病人鼻窦黏膜组织中呈高表达现象,在CRS发生发展中有重要的作用,且与预后有一定关系。因此本研究拟探讨外周血NLR、IL-6在预测CRS术后复发中的临床价值。
-
CRS组病人中性粒细胞计数、NLR及IL-6水平均明显高于对照组(P < 0.01),而淋巴细胞计数明显低于对照组(P < 0.01)(见表 1)。
分组 n 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) NLR IL-6/(μg/L) 对照组 40 4.25±0.83 1.60±0.52 2.86±0.95 33.12±2.54 CRS组 87 5.89±2.12 1.15±0.36 5.41±1.67 52.73±6.61 t — 4.72 5.65 9.00 18.13 P — < 0.01 < 0.01 < 0.01 < 0.01 表 1 CRS组与对照组外周血相关指标比较(x±s)
-
术后复发组中性粒细胞计数、NLR及IL-6水平均明显高于术后未复发组(P < 0.01),而淋巴细胞计数明显低于术后未复发组(P < 0.01)(见表 2)。
分组 n 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) NLR IL-6/(μg/L) 术后复发组 30 6.82±1.96 1.02±0.32 6.72±2.31 58.03±7.43 术后未复发组 57 5.05±1.02 1.33±0.21 3.80±0.76 47.36±5.95 t — 5.55 5.43 8.73 7.29 P — < 0.01 < 0.01 < 0.01 < 0.01 表 2 术后复发组与术后未复发组外周血相关指标比较(x±s)
-
采用ROC分析外周血NLR、IL-6单一和联合检测预测CRS鼻内镜术后复发的价值,结果显示外周血NLR、IL-6联合检测的灵敏度、特异度及曲线下面积均高于单独检测(P < 0.01)(见表 3)。
指标 截断值 灵敏度/% 特异度/% 曲线下面积 95%CI NLR 4.42 73.33 70.18 0.683 0.655~0.711 IL-6 51.74 μg/L 66.67 68.42 0.622 0.609~0.635 NLR+IL-6 — 86.67 82.46 0.871 0.847~0.895 表 3 外周血NLR及IL-6单一和联合检测预测CRS鼻内镜术后复发的价值分析
外周血中性粒细胞数与淋巴细胞数比值、白细胞介素-6预测慢性鼻窦炎鼻内镜术后复发的价值
Value of neutrophil to lymphocyte ratio and interleukin-6 level in peripheral blood in predicting the recurrence of chronic rhino sinusitis after endoscopic sinus surgery
-
摘要:
目的探讨外周血中性粒细胞数与淋巴细胞数比值(NLR)、白细胞介素(IL)-6在预测慢性鼻窦炎(CRS)鼻内镜术后复发中的临床价值。 方法选择行鼻内镜术治疗的87例CRS病人作为研究对象,根据术后是否疾病复发分为术后复发组(n=30例)和术后未复发组(n=57例)。同期选择40名健康体检者作为对照组。采用全自动血生化仪检测各组外周血中性粒细胞、淋巴细胞水平,并计算NLR,同时采用酶联免疫吸附法检测各组外周血IL-6水平。比较各组中性粒细胞计数、淋巴细胞计数、NLR及IL-6水平,采用受试者工作特征曲线分析外周血NLR、IL-6单一和联合检测预测CRS鼻内镜术后复发的价值。 结果CRS病人中性粒细胞计数、NLR及IL-6水平均明显高于对照组(P < 0.01),而淋巴细胞计数明显低于对照组(P < 0.01);术后复发组中性粒细胞计数、NLR及IL-6水平均明显高于术后未复发组(P < 0.01),而淋巴细胞计数明显低于术后未复发组(P < 0.01);外周血NLR、IL-6联合检测的灵敏度、特异度及曲线下面积均明显优于外周血NLR、IL-6单一检测(P < 0.01)。 结论外周血NLR、IL-6联合检测预测CRS鼻内镜术后复发具有较好的临床价值。 -
关键词:
- 鼻窦炎 /
- 中性粒细胞数与淋巴细胞数比值 /
- 白细胞介素-6 /
- 鼻内镜术
Abstract:ObjectiveTo explore the clinical value of neutrophil to lymphocyte ratio(NLR)and interleukin(IL)-6 level in peripheral blood in predicting the recurrence of chronic rhino sinusitis(CRS)after endoscopic sinus surgery. MethodsEighty-seven patients with CRS treated with endoscopic sinus surgery were divided into the postoperative recurrence group(30 cases)and non-recurrence group(57 cases)according to the disease recurrence after surgery, and 40 healthy people were set as the control group at the same period.The levels of neutrophils and lymphocytes in peripheral blood in two groups were detected by automatic blood biochemical analyzer to calculate the NLR.Meanwhile, the levels of IL-6 in peripheral blood of each group were detected by enzyme-linked immunosorbent assay.The neutrophil count, lymphocyte count, NLR and IL-6 levels were compared between two groups.The receiver operating characteristic curve was used to analyze the value of single and combined peripheral blood NLR and IL-6 detection in predicting the recurrence of CRS after endoscopic sinus surgery. ResultsThe neutrophil count, NLR and IL-6 levels in CRS group were significantly higher than those in control group(P < 0.01), while the lymphocyte count in CRS group was significantly lower than that in control group(P < 0.01).The neutrophil count, NLR and IL-6 levels in recurrence group were significantly higher than those in non-recurrence group(P < 0.01), while the lymphocyte count in recurrence group was significantly lower than that in non-recurrence group(P < 0.01).The sensitivity, specificity and area under the curve of the combined detection of peripheral blood NLR and IL-6 were significantly better than those of single detection of peripheral blood NLR and IL-6(P < 0.01). ConclusionsThe combined detection of NLR and IL-6 in peripheral blood has good clinical values to predict the recurrence of CRS after endoscopic sinus surgery. -
表 1 CRS组与对照组外周血相关指标比较(x±s)
分组 n 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) NLR IL-6/(μg/L) 对照组 40 4.25±0.83 1.60±0.52 2.86±0.95 33.12±2.54 CRS组 87 5.89±2.12 1.15±0.36 5.41±1.67 52.73±6.61 t — 4.72 5.65 9.00 18.13 P — < 0.01 < 0.01 < 0.01 < 0.01 表 2 术后复发组与术后未复发组外周血相关指标比较(x±s)
分组 n 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) NLR IL-6/(μg/L) 术后复发组 30 6.82±1.96 1.02±0.32 6.72±2.31 58.03±7.43 术后未复发组 57 5.05±1.02 1.33±0.21 3.80±0.76 47.36±5.95 t — 5.55 5.43 8.73 7.29 P — < 0.01 < 0.01 < 0.01 < 0.01 表 3 外周血NLR及IL-6单一和联合检测预测CRS鼻内镜术后复发的价值分析
指标 截断值 灵敏度/% 特异度/% 曲线下面积 95%CI NLR 4.42 73.33 70.18 0.683 0.655~0.711 IL-6 51.74 μg/L 66.67 68.42 0.622 0.609~0.635 NLR+IL-6 — 86.67 82.46 0.871 0.847~0.895 -
[1] 苏怡, 谢景华, 潘晓李, 等. 慢性鼻-鼻窦炎伴或不伴鼻息肉患者鼻内镜手术的疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 86. [2] 伦杰, 张亚楠. 慢性鼻-鼻窦炎伴鼻息肉复发的相关影响因素分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 80. [3] 陈秋桓, 何援春, 李琴. 慢性鼻窦炎伴鼻息肉患者术后复发相关因素分析[J]. 海南医学, 2016, 27(12): 2022. doi: 10.3969/j.issn.1003-6350.2016.12.044 [4] MAYDA H, AHSEN A, BAGCIOGLU E, et al. Effect of increased neutrophil-to-lymphocyte ratio(NLR)and decreased mean platelet volume(MPV)values on inflammation in acute mania[J]. Noro Psikiyatr Ars, 2016, 53(4): 317. doi: 10.5152/npa.2016.10272 [5] 张炜, 曾昱菡, 余先崧. 慢性鼻窦炎手术前后ECP、EGF、IL-6的水平变化及临床意义[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 63. [6] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组, 中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 慢性鼻-鼻窦炎诊断和治疗指南: 2012年, 昆明[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(2): 92. doi: 10.3760/cma.j.issn.1673-0860.2013.02.002 [7] JENKS M, WILLITS I, TURNER EE, et al. The XprESS multisinus dilation system for the treatment of chronic sinusitis: a NICE medical technology guidance[J]. Appl Health Econ Health Policy, 2017, 15(5): 567. doi: 10.1007/s40258-017-0337-7 [8] RAI G, DAS S, ANSARI MA, et al. Phenotypic and functional profile of Th17 and Treg cells in allergic fungal sinusitis[J]. Int Immunopharmacol, 2018, 57: 55. doi: 10.1016/j.intimp.2018.02.009 [9] MENG XC, CHANG Q, LIU YY, et al. Determinant roles of gender and age on SII, PLR, NLR, LMR and MLR and their reference intervals defining in Henan, China: a posteriori and big-data-based[J]. J Clin Lab Anal, 2018, 32(2): e22228. doi: 10.1002/jcla.22228 [10] RAJWA P, ZYCZKOWSKI M, PARDDYSZ A, et al. Evaluation of the prognostic value of LMR, PLR, NLR and dNLR in urothelial bladder cancer patients treated with radical cystectomy[J]. Eur Rev Med Pharmacol Sci, 2018, 22(10): 3027. [11] HU Z, CHAI J. Structural mechanisms in NLR inflammasome assembly and signaling[J]. Curr Top Microbiol Immunol, 2016, 397: 23. [12] 张劼, 龚齐. 不同分型慢性鼻-鼻窦炎患者外周血嗜酸性粒细胞与中性粒细胞百分比及变态反应临床差异性分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 54. [13] 徐文中, 刘春艳. 过敏性鼻炎患儿淋巴细胞亚群、血清IgE水平的变化及其相关性[J]. 中国免疫学杂志, 2016, 32(4): 550. doi: 10.3969/j.issn.1000-484X.2016.04.022 [14] 王冰, 舒艳, 梁佳, 等. IL-6在儿童慢性鼻窦炎中的表达及其意义[J]. 重庆医学, 2016, 45(1): 19. doi: 10.3969/j.issn.1671-8348.2016.01.007 [15] 范隽, 赵昌敏, 刘兆芳, 等. p38MAPK信号通路调控IL-6、HIF-1α及VEGF对慢性鼻-鼻窦炎发病机制的影响[J]. 中国当代医药, 2017, 24(9): 8. doi: 10.3969/j.issn.1674-4721.2017.09.003