Correlation Between Neutrophil/Lymphocyte Ratio (NLR) And Activity Of Moderate To Severe Psoriasis Vulgarisand And TCM Syndrome Types

ObjectiveIn this study the correlation between neutrophil/lymphocyte ratio(NLR)and the activity of moderate to severe psoriasis vulgaris was analyzed,and the efficacy of independent and combined evaluation of disease activity by NLR and CRP was compared,aiming to find simple,low-cost and easily evaluated markers reflecting psoriasis activity.At the same time,the hematological indexes of patients with psoriasis of different TCM syndromes were compared in an attempt to provide possible objective indexes for TCM syndrome.Methods1.From August 2018 to January 2019,70 patients with moderate to severe psoriasis vulgaris admitted to the dermatology department of Wuhan No.1Hospital who met the discharge criteria were selected as the case group and 50 healthy people as the control group.WBC,NEU,LYM,PLT,platelet/lymphocyte ration and neutrophil/ lymphocyte ratio(NLR)were compared between the two groups.2.According to the activity of the disease,70 patients with moderate to severe psoriasis vulgaris were divided into three groups: active group,stable group and regression group.Patients were divided into two groups according to psoriasis area and severity index PASI score: moderate group(10 ≤ PASI <15)and severe group(PASI ≥ 15);according to TCM syndrome types,theywere divided into blood heat syndrome group,blood dryness syndrome group and blood stasis syndrome group.According to different groups,WBC,NEU,LYM,PLT,platelet/lymphocyte ratio(PLR),neutrophil/lymphocyte ratio(NLR),erythrocyte sedimentation rate,C-reactive protein and PASI score were compared respectively.3.The correlation between NLR,CRP,ESR and PASI scores was analyzed.Logistic regression was used to analyze the influencing factors of psoriasis disease activity,and ROC curve was used to evaluate the predictive effect of NLR and CRP levels on psoriasis disease activity.Results1.Compared with healthy control group,NLR and PLR of patients with psoriasis vulgaris were significantly higher than those of healthy control group,and LYM was lower than that of healthy control group(p<0.05).However,WBC,NEU,PLT had no significant difference compared with the healthy control group(p>0.05).2.In the case group,the moderate group(10≤PASI<15)was compared with the severe group(PASI≥15): WBC,NEU,PLR,NLR,ESR,CRP in severe psoriasis vulgaris group were significantly higher than those in moderate psoriasis vulgaris group,while LYM in moderate psoriasis vulgaris group was higher than that in severe psoriasis vulgaris group(p<0.05).However,there was no significant difference in PLT between the two groups(p>0.05).3.Comparison of the three groups of active,stable and regressive periods in the case group:(1)In patients with moderate psoriasis vulgaris,there were no significant differences in WBC,NEU,LYM,PLT,PLR,ESR,and PASI scores between active,stable,and regressive patients.Compared with the active period,the CRP of patients with stable and regressive period was significantly lower thanthat of patients with active psoriasis.The difference was statistically significant(P<0.05).The CRP of patients with regressive period was lower than that of stable period(P<0.05).In addition,NLR was significantly lower in the regressive period than in the relapsed period(P<0.05).There was no significant difference in NLR between active phase and stable phase,stable phase and regression phase(P>0.05).(2)In patients with severe psoriasis vulgaris,there were no significant differences in WBC,NEU,PLT,PLR,and PASI scores between active,stable,and regressive patients.Compared with the active period,the NLR,CRP and ESR of the patients in the stable and regressive period were significantly lower than those in the active period,and the difference was statistically significant(P<0.05).while NLR and ESR of patients in regression phase have no statistically significant difference compared with stable phase(P>0.05).Compared with regression period,LYM of patients in active period and stable period was significantly lower than that of patients with psoriasis in regression period(P<0.05).4.Comparison among three groups of blood heat syndrome,blood dryness syndrome and blood stasis syndrome: In patients with moderate to severe psoriasis vulgaris,WBC,LYM,PLT and PLR of patients with blood heat syndrome,blood dryness syndrome and blood stasis syndrome have no statistical significance.Compared with the blood-heat syndrome,the NEU,NLR,ESR,CRP,and PASI scores of patients with blood-stagnation syndrome and blood-stasis syndrome were significantly lower than those with blood-heat syndrome(P<0.05).Among these parameters,the CRP of patients with blood stasis syndrome was lower than that of blood-stasis syndrome(P<0.05).The difference of NEU,NLR,ESR,PASI scores between blood-stasis syndrome and blood stasis syndrome was not statistically significant.5.Correlation analysis and logistic regression: NLR was positivelycorrelated with CRP in patients with psoriasis vulgaris(r=0.429,p<0.05);NLR was positively correlated with ESR(r=0.574,p<0.05);NLR was positively correlated with PASI score(r=0.536,p<0.05);PASI score was positively correlated with ESR(r=0.320,p<0.05);PASI score was positively correlated with CRP(r=0.382,p<0.05).Logistics regression showed that NLR and CRP were associated with psoriasis disease activity(p<0.05).6.Analysis of ROC Curve(1)When NLR is 2.43,the diagnostic efficiency is the highest,and the area under the ROC curve is 0.810.At this time,the sensitivity is 74% and the specificity is 85%.(2)When CRP is 5.99,the diagnostic efficiency is the highest,and the area under the ROC curve is 0.851.At this time,the sensitivity is 87% and the specificity is 83%.(3)NLR combined with CRP,the diagnostic efficiency is higher than the single index of NLR or CRP,the area under the ROC curve is 0.901,the sensitivity is 91%,and the specificity is 80%.Conclusion: Neutrophil/lymphocyte ratio(NLR)and CRP are correlated with the activity of moderate to severe psoriasis vulgaris,and can be used as one of the indexes for judging the activity of psoriasis.NLR has reference significance in distinguishing psoriasis with blood heat syndrome and non-blood heat syndrome(blood dryness syndrome and blood stasis syndrome).