干燥综合征患者发生重症新型冠状病毒肺炎的早期预测

doi:10.19723/j.issn.1671-167X.2023.06.008

摘要/Abstract

摘要：

目的: 探讨血细胞比值及炎症指标对干燥综合征(primary Sjögren’ s syndrome，PSS)合并新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)预后不良的预测价值。方法: 选择2022年12月至2023年2月在南昌大学第一附属医院风湿免疫科就诊并具有所需完整临床资料的80例干燥综合征合并COVID-19患者进行回顾性分析，纳入标准: (1)符合2019年美国风湿病学会(American College of Rheumatology，ACR)干燥综合征诊断标准；(2)经实时逆转录聚合酶链式反应严重急性呼吸综合征冠状病毒2核酸检测或抗原检测确诊的COVID-19患者; (3)有所需完整临床资料；(4)年龄>18岁。依据《新型冠状病毒肺炎诊疗方案(试行第十版)》临床分型标准，将轻型、普通型患者合为轻症组，重型及危重型合为重症组。干燥综合征疾病活动判定方法参考欧洲抗风湿病联盟(European League Against Rheumatism，EULAR)制定的干燥综合征病情评估指数(EULAR Sjögren’ s syndrome disease activity index，ESSDAI)评分。比较两组患者感染后24~72 h内的血小板-淋巴细胞比值(platelet-lymphocyte ratio，PLR)和C反应蛋白-淋巴细胞比值(C-reactive protein-lymphocyte ratio，CLR)及红细胞沉降率(erythrocyte sedimentation rate，ESR)、C反应蛋白(C-reactive protein，CRP)等实验室资料。结果: 轻症组66例，平均年龄(51.52±13.16)岁；重症组14例，平均年龄(52.64±10.20)岁。重症组患者的疾病活动度、CRP、血小板、PLR和CLR明显高于轻症组(P＜0.05)。以轻、重症为因变量，分别以年龄、疾病活动度、CRP、血小板、PLR和CLR作为自变量进行单因素分析，提示疾病活动、CRP、PLR和CLR与COVID-19的严重程度相关(P＜0.05)。多因素二元Logisitic回归分析进一步证实PLR(OR=1.016，P＜0.05)、CLR(OR=1.504，P＜0.05)是COVID-19重症患者的独立危险因素。ROC曲线分析显示PLR和CLR的曲线下面积分别为0.708(95%CI: 0.588~0.828)和0.725(95%CI: 0.578~0.871)，敏感度分别为0.429和0.803，特异度分别为0.714和0.758，PLR和CLR的最佳分界值分别为166.214和0.870。结论: PLR和CLR，尤其是CLR，或许是预测干燥综合征患者COVID-19预后的简易而有效的指标。

关键词: 干燥综合征, 新型冠状病毒肺炎, 预后, 血小板-淋巴细胞比值, C反应蛋白-淋巴细胞比值

Abstract:

Objective: To investigate the predictive value of blood cell ratios and inflammatory markers for adverse prognosis in patients with primary Sjögren’s syndrome (PSS) combined with coronavirus disease 2019 (COVID-19). Methods: We retrospectively collected clinical data from 80 patients with PSS and COVID-19 who visited the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University from December 2022 to February 2023. Inclusion criteria were (1) meeting the American College of Rheumatology (ACR) classification criteria for Sjögren’s syndrome; (2) confirmed diagnosis of COVID-19 by real-time reverse transcription polymerase chain reaction or antigen testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); (3) availability of necessary clinical data; (4) age > 18 years. According to the clinical classification criteria of the "Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (trial the 10th Revised Edition)", the patients were divided into the mild and severe groups. Disease activity in primary Sjögren' s syndrome was assessed using the European League Against Rheumatism (EULAR) Sjögren' s syndrome disease activity index (ESSDAI). Platelet-lymphocyte ratio (PLR), C-reactive protein-lymphocyte ratio (CLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and other laboratory data were compared between the two groups within 24-72 hours post-infection. Results: The mild group consisted of 66 cases with an average age of (51. 52±13. 16) years, and the severe group consisted of 14 cases with an average age of (52.64±10.20) years. Disease activity, CRP, platelets, PLR, and CLR were significantly higher in the severe group compared with the mild group (P < 0.05). Univariate analysis using age, disease activity, CRP, platelets, PLR, and CLR as independent variables indicated that disease activity, CRP, PLR, and CLR were correlated with the severity of COVID-19 (P < 0.05). Multivariate logistic regression analysis further confirmed that PLR (OR=1.016, P < 0.05) and CLR (OR=1.504, P < 0.05) were independent risk factors for the severity of COVID-19 in the critically ill patients. Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for PLR and CLR was 0.708 (95%CI: 0.588-0.828) and 0.725 (95%CI: 0.578-0.871), respectively. The sensitivity for PLR and CLR was 0.429 and 0.803, respectively, while the highest specificity was 0.714 and 0.758, respectively. The optimal cutoff values for PLR and CLR were 166.214 and 0.870, respectively. Conclusion: PLR and CLR, particularly the latter, may serve as simple and effective indicators for predicting the prognosis of patients with PSS and COVID-19.

Key words: Primary Sjögren's syndrome, Coronavirus disease 2019 (COVID-19), Prognosis, Platelet-lymphocyte ratio, C-reactive protein-lymphocyte ratio

中图分类号:

R593.2

李建斌,吕梦娜,池强,彭一琳,刘鹏程,吴锐. 干燥综合征患者发生重症新型冠状病毒肺炎的早期预测[J]. 北京大学学报（医学版）, 2023, 55(6): 1007-1012.

Jian-bin LI,Meng-na LYU,Qiang CHI,Yi-lin PENG,Peng-cheng LIU,Rui WU. Early prediction of severe COVID-19 in patients with Sjögren’s syndrome[J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1007-1012.

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Parameters	Mild group (n=66)	Severe group (n=14)	t/χ²/Z	P
Age/years, ${\bar x}$±s	51.52±13.16	52.64±10.20	-0.301	0.764
Gender, n(%)			0.653	0.516
Male	2 (3)	0 (0)
Female	64 (97)	14 (100)
Disease activity, n(%)	5 (7)	6 (42.82)	-3.549	0.001
ESR/(mg/L), ${\bar x}$±s	18.42±9.83	17.86±10.29	0.193	8.848
CRP/(μmol/L), M(P₂₅，P₇₅)	0.72 (0.20，1.68)	1.54 (0.54，9.40)	-2.463	0.014
White blood cells/(×10⁹/L), ${\bar x}$±s	5.86±1.95	5.06±1.42	1.447	0.152
Platelets/(×10⁹/L), ${\bar x}$±s	213.42±69.08	253.86±61.02	-2.027	0.046
Monocytes/(×10⁹/L), M(P₂₅，P₇₅)	0.34 (0.28，0.54)	0.34 (0.29，0.56)	-0.120	0.904
Lymphocytes/(×10⁹/L), ${\bar x}$±s	1.79±0.65	1.59±0.41	1.115	0.268
Neutrophils/(×10⁹/L), M(P₂₅，P₇₅)	3.45 (2.32，4.52)	2.94 (2.59，3.98)	-0.684	0.494
Immunoglobulin G/(g/L), ${\bar x}$±s	15.21±4.68	14.32±2.66	0.586	0.560
Immunoglobulin A/(g/L), ${\bar x}$±s	2.79±0.94	2.52±1.27	0.781	0.438
Immunoglobulin M/(g/L), ${\bar x}$±s	1.47±1.06	1.18±0.43	0.857	0.395
Complement C3(g/L), ${\bar x}$±s	0.79±0.12	0.73±0.10	1.309	0.196
Complement C4(g/L), ${\bar x}$±s	0.19±0.05	0.20±0.06	-0.532	0.597
NLR, ${\bar x}$±s	2.38±2.21	2.14±1.15	0.408	0.685
PLR, ${\bar x}$±s	129.95±51.73	163.92±37.90	-2.324	0.023
CLR, M(P₂₅，P₇₅)	0.42 (0.18，0.88)	1.02 (0.37，4.99)	-2.628	0.009
LMR, ${\bar x}$±s	4.75±2.20	4.34±1.52	0.665	0.508
Disease course/years, ${\bar x}$±s	6.96±5.08	9.57±4.03	-1.772	0.081
Medication
Corticosteroids, n(%)	31 (46.97)	8 (57.14)	-0.090	0.928
Methylprednisolone, n(%)	10 (15.15)	3 (21.42)	-0.214	0.831
Hydroxychloroquine, n(%)	24 (36.36)	7 (50)	-0.312	0.755
Cyclosporine, n(%)	3 (4.54)	0 (0)	-0.904	0.366

Parameters	β	SE	Wald	P	OR	95%CI
Disease Activity^a	1.597	0.822	3.775	0.052	4.909	0.986-24.752
CRP^a	0.186	0.102	3.349	0.067	1.205	0.987-1.471
PLR^a，b	0.015	0.007	5.146	0.023	1.016	1.002-1.029
CLR^b	0.408	0.166	5.983	0.014	1.504	1.084-2.085

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