Significance Of Blood Routine And Coagulation Function In The Diagnosis Of Ulcerative Colitis

BACKGROUND:Ulcerative colitis(UC)is a relatively common gastrointestinal disease.The lesions mainly occur in the mucosa and submucosa.The main clinical manifestations are persistent or recurrent diarrhea and mucus pus and blood.Epidemiology in China shows that the incidence of ulcerative colitis has increased significantly in the past 20 years.Among them,the incidence of young people is higher than that of older people.In addition to the assessment of clinical symptoms,the diagnosis of ulcerative colitis needs to understand the healing of mucosa under endoscopy and mainly depends on the colonscopy.Endoscopy can intuitively understand mucosal damage and healing,but frequent endoscopy increases the psychological and economic burden of patients,and even complications such as toxic megacolon appear.Therefore,we analyzed the relationship between blood routine,coagulation function and other indicators of patients with ulcerative colitis and the changes of the disease and hope to find out the relationship of them,so as to find more simple,diagnostic value and more sensitive indicators to help judge the disease.OBJECTIVE:To explore the changes of blood routine and coagulation function and their clinical significance in the ulcerative colitis group,and to explore the diagnostic significance of each index in patients with ulcerative colitis.METHODS:From January 2017 to December 2019,patients with ulcerative colitis with clear endoscope and pathological diagnosis in the Department of Gastroenterology of Huaihe Hospital of Henan University were selected as the research subjects,and patients with normal endoscopic performance during the same time were enrolled as control group.There were 122 cases in the ulcerative colitis group and 80 cases in the normal control group.They were divided into different subgroups according to Mayo score,Montreal classification,endoscopic performance,and clinical type.The basic information and clinical manifestations(age,gender,previous medical history,body temperature,stool frequency at the time of admission,blood in the stool)of the patients enrolled were counted,the first blood routine after admission,CRP,ESR,coagulation function and colonoscopy report.The changes of blood routine and coagulation function in different subgroups of ulcerative colitis were compared,and the diagnostic significance of various indicators in the diagnosis of ulcerative colitis was analyzed.RESULTS:1.There were significant differences in white blood cell count,neutrophil count,platelet count and NLR between ulcerative colitis group and control group(P < 0.001),but PLR(platelet / lymphocyte count ratio)had no statistical significance(P = 0.843).There were significant differences in leukocyte count,neutrophil count,platelet count,NLR and PLR among different activity levels(P < 0.01),but no significant difference in lymphocyte count(P = 0.714).There were significant differences in platelet count,NLR and PLR among different lesions(P < 0.05),but there was no significant difference in WBC and neutrophil count(P > 0.05).There were significant differences in WBC count,neutrophil count,platelet count and PLR among different endoscopic manifestations(P < 0.05),but there was no significant difference in NLR(P = 0.153).There was no significant difference in Blood Routine Indexes among different clinical types(P > 0.05)2.Compared with the control group,the differences of activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),CRP and ESR in ulcerative colitis group were statistically significant(P < 0.05).There were significant differences in FIB,CRP and ESR among different activity levels(P < 0.01),but there was no significant difference in APTT and PT(P > 0.05).The differences of APTT,FIB,CRP and ESR were statistically significant(P < 0.05),but there was no significant difference in PT(P = 0.239).There were significant differences in APTT,FIB,CRP and ESR among different endoscopic manifestations(P < 0.05),but there was no significant difference in PT(P = 0.075).There was no significant difference in coagulation function,CRP and ESR among different clinical types(P > 0.05).3.The area under ROC curve of NLR and neutrophil count was 0.776,which was higher than other indexes including ESR and CRP.The sensitivity of NLR was higher than that of neutrophil count,but lower than that of ESR.The sensitivity of ESR in the diagnosis of ulcerative colitis activity was the highest(73.9%).CRP was the highest activity specificity in the diagnosis of ulcerative colitis(88.0%).The logistic regression analysis of blood routine test,coagulation function and ESR showed that the area under ROC curve of blood routine combined with coagulation function and blood routine combined with ESR were 0.848 and 0.837 respectively,which were higher than the single detection results of each index,and the specificity could be increased to more than 90%.In this study,the critical value of NLR is 2.14(AUC = 0.776,95% CI: 0.709-0.843),the critical value of neutrophil count is 3.75×109 / L(AUC = 0.776,95% CI: 0.710-0.842),the critical value of fibrinogen is 337.5ml/dl(AUC = 0.738,95% CI: 0.668-0.808),critical value of ESR is 16.5mm / 1h(AUC = 0.729,95% CI: 0.627-0.831)(AUC = 0.729,95% CI: 0.627-0.831).4.The area under the ROC curve of fibrinogen was the largest(AUC = 0.736),which was higher than the diagnostic value of ESR;PLR had the highest sensitivity in the diagnosis of severe ulcerative colitis,up to 87.0%;the specificity of neutrophil count in the diagnosis of severe ulcerative colitis was 81.5%,but the area under the ROC curve was higher than that of ESR The sensitivity was lower than other indexes.After logistic regression analysis,we found that the area under the curve and the sensitivity of blood routine combined with ESR were higher than that of single detection(AUC = 0.741,sensitivity = 82.6%),while the area under ROC curve,specificity and sensitivity of blood routine combined with coagulation function and coagulation function combined with ESR did not change significantly.In this study,the critical value of fibrinogen was 379.5mg/dl(AUC = 0.736,95% CI: 0.635,0.837),the critical value of PLR was 136.7(AUC = 0.664,95% CI: 0.541-0.787),and the critical value of ESR was 31.5mm/1h(AUC = 0.729,95% CI: 0.627-0.831).CONCLUSION:1.Neutrophil count,platelet count and NLR are related to the activity of ulcerative colitis and the severity of the disease.2.Fibrinogen and APTT in coagulation function are related to the activity of ulcerative colitis,in which fibrinogen is related to the severity of the disease,while APTT is not related to the severity of the disease.3.NLR may be used as a new index to judge the activity of ulcerative colitis;fibrinogen may be used as a new index to diagnose severe ulcerative colitis.4.The join-detection of blood routine test,coagulation function and ESR can improve the diagnosis of disease activity and severity.