南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (04): 453-458.doi: 10.12122/j.issn.1673-4254.2020.04.01

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52周英夫利西疗程中第14周中性粒细胞与淋巴细胞比值可预测克罗恩患者是否对治疗产生失应答

高 倩，董红霞，李 瑾   

  • 出版日期:2020-04-30 发布日期:2020-04-20

Neutrophil-lymphocyte ratio at 14th week predicts loss ofresponse to 52-week infliximab therapy in patients withCrohn’s disease

  • Online:2020-04-30 Published:2020-04-20

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摘要： 目的 探索英夫利西（IFX）疗程中第14周时获得的中性粒细胞与淋巴细胞比值（NLR）能否预测克罗恩患者中失应答的发生。方法 2012年1月~2016年12月，54名克罗恩患者在武汉市中南医院接受了IFX治疗。所有患者在诱导治疗后均得到了缓解，并且在治疗开始后52周内定期回医院接受治疗。我们回顾性分析了这些病人的资料，以了解14周时的NLR值与IFX失应答的相关性。结果 54名克罗恩患者中，15（27.8%）名在接下来的疗程中出现了IFX失应答。相较于持续应答的患者，失应答患者第14周时的NLR值更高[3.51（2.90~6.25）vs 1.77（1.2~2.56），P=0.00]，受试者工作特征曲线分析发现在52周的治疗中，14周 时NLR值预测克罗恩患者发生IFX失应答的最佳截点是2.75。该截点对应的敏感性为93.331%，特异性为84.62%，曲线下面积为0.903（0.731~0.959）。单因素分析发现14周时NLR值与无复发生存率相关（P=0.00），多因素分析发现14周时NLR值对克罗恩患者发生IFX失应答有独立预测作用，其风险比（OR）为1.851（95% CI: 1.096~3.026，P=0.021）。结论 IFX疗程第14周时所获得的NLR值是预测克罗恩患者发生IFX失应答的一项有效指标。

Abstract: Objective Loss of response (LOR) has become an important clinical problem in patients with Crohn’s diseasereceiving infliximab (IFX) treatment. Neutrophil-lymphocyte ratio (NLR) has been shown to correlate with the activity ofinflammatory bowel disease (IBD), and NLR at the 14th week of IFX therapy potentially allows the prediction of sustainedresponse to IFX in Crohn’s patients. The aim of this study was to explore whether NLR at the 14th week of IFX therapy couldpredict the occurrence of LOR to IFX in Crohn’s patients. Methods Between January, 2012 and December, 2016, 54 patientswith Crohn’s disease underwent a 52-week treatment with IFX and successfully achieved response to the induction treatmentin Zhongnan Hospital. We retrospectively examined their medical records and assessed the association between NLR at 14weeks and LOR during IFX therapy. Results Of the 54 patients, 15 (27.8%) showed LOR to IFX during the follow-up. We noteda significant increase in NLR at 14 weeks in the patients with LOR as compared with the patients with sustained response toIFX [3.51 (2.9-6.25) vs 1.77 (1.23-2.56), P=0.00]. Receiver-operating characteristic analysis showed that at the cut-off value of 2.75,NLR at 14 weeks was predictive of LOR within 52 weeks of IFX therapy with a sensitivity of 93.33% and a specificity of 84.62%,and the area under curve (AUC) of NLR was 0.903 (0.731-0.959). Univariate analysis revealed a significant correlation betweenrelapse- free survival and the NLR at 14 weeks (P=0.00). Multivariate analysis identified NLR at 14 weeks as an independentprognostic factor for LOR with a hazard ratio of 1.851 (95% CI: 1.096-3.026, P=0.021). Conclusion NLR at the 14th week duringIFX therapy is a useful predictor for LOR in patients with Crohn’s disease.