| ObjectiveThis study aims to explore the changes of the neutrophil-ymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),lymphocyte-monocyte ratio(LMR),systemic immune inflammation index(SII)and C-reactive protein/albumin ratio(CRP/ALB)in inflammatory bowel disease(IBD)and its predictive value for disease activity.Methods1.Research methods A retrospective study was used to enroll 212 patients with IBD who attended the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 as the research subjects,including 145 patients with ulcerative colitis(UC)and 67 patients with Crohn’s disease(CD);133 healthy people with matching gender and age were selected as the control group during the same period.2.Data collection Collect clinical data of all research subjects,including general data(gender,age,height,weight),clinical manifestations,medical history and physical examination,laboratory examination,endoscopic and mucosal biopsy,imaging examination results,etc.3.Experimental methods The fasting venous blood of all study subjects in the morning was collected,and the blood routine,albumin,erythrocyte sedimentation rate,C-reactive protein,procalcitonin and other serological indicators were tested by the Laboratory Department of the First Affiliated Hospital of Zhengzhou University.The modified Mayo score was used to evaluate UC disease activity,and the Best Crohn activity index calculation method was used to evaluate CD disease activity.4.Statistical methods The SPSS23.0 statistical software was used to perform statistical analysis on all data.The measurement data was evaluated by Kolmogorov-Smirnov test combined with QQ chart to evaluate whether it was a normal distribution.Normally distributed data were expressed as mean±standard deviation(x±s).The independent sample t test was used for the comparison between the two groups,and the one-way ANOVA analysis was used for the comparison between multiple groups.Non-normal distribution data is represented by M(P25,P75),and non-parametric Mann-Whitney U test or Kruskal-Wallis H test is used for comparison between groups.Count data is expressed as the number of cases or percentages,and the comparison between groups uses the χ2 test.The correlation between variables was analyzed by Spearman correlation.Draw the receiver operating characteristic(Receiver operating characteristic,ROC)curve,calculate the Youden index to get the cut-off value.The difference was statistically significant with P<0.05.Results1.Comparison of inflammation indexes between IBD group and control groupCompared with the control group,NLR,PLR,SII,CRP/ALB in the IBD group were significantly increased,and the difference was statistically significant(Z=-8.214,-7.435,-8.041,-6.925,P<0.001),and LMR was significantly decreased,The difference is statistically significant(Z=-10.485,P<0.001).2.Comparison of inflammation indexes in UC group,CD group and control groupCompared with the control group,NLR PLR SII,CRP/ALB in the UC group were significantly increased,and the difference was statistically significant(Z=-7.489,-6.16,-7.205,-5.580,P<0.05),and LMR was significantly decreased-The difference was statistically significant(Z=-8.354,P<0.05).In the CD group,NLR,PLR,SII,CRP/ALB were significantly increased,and the difference was statistically significant(Z=-6.191,-6.752,-6.279,-6.491,P<0.001),and LMR was significantly decreased,and the difference was statistically significant(Z=-9.992,P<0.001).3.Comparison of Inflammatory Indexes in the Remission Period and the Active Period in the UC and CD GroupsIn the UC group,compared with the indicators in the remission phase,the NLR,PLR,SII,CRP/ALB in the active phase were significantly increased,and the difference was statistically significant(Z=-2.261,-2.225,-2.045,-2.031,P<0.05),LMR decreased significantly,and the difference was statistically significant(Z=-3.674,P<0.05).In the CD group,compared with the indicators in the remission period,NLR,PLR,SII,CRP/ALB in the active period were significantly increased,and the difference was statistically significant(Z=-2.877,-2.811,-2.833,-2.942,P<0.05),LMR decreased significantly,and the difference was statistically significant(Z=-2.218,P<0.05).4.Comparison of inflammatory indexes between different disease severity in UC group and CD groupIn the UC group,compared with the remission group indicators,NLR,PLR,SII,CRP/ALB were significantly increased in moderately and severely active patients,and LMR was significantly reduced in severely active patients,and the difference was statistically significant(P<0.05).Compared with patients in mildly active phase,NLR,PLR,SII,CRP/ALB were significantly increased in moderately and severely active patients,and LMR was significantly reduced in severely active patients,and the difference was statistically significant(P<0.05)).In the CD group,compared with the indicators in the remission group,NLR,PLR,SII,CRP/ALB were significantly increased in moderately and severely active patients,and LMR was significantly reduced in severely active patients,and the difference was statistically significant.(P<0.05).Compared with patients in mildly active phase,NLR,PLR,SII,CRP/ALB were significantly increased in moderately and severely active patients,and LMR was significantly reduced in moderately and severely active patients,and the difference was statistically significant(P<0.05).5.Correlation Analysis of Inflammation Indexes and Disease Activity Indexes of UC and CDIn the UC group,NLR was positively correlated with CRP,ESR,and Mayo scores(rs=0.397,0.261,0.456,P<0.05),and PLR was positively correlated with CRP,ESR,and Mayo scores(rs=0.323,0.263,0.476,P<0.05)),LMR is negatively correlated with CRP,ESR,and Mayo score(rs=-0.269,-0.222,-0.381,P<0.05),and SII is positively correlated with CRP,ESR,and Mayo score(rs=0.465,0.298,0.501,P<0.05),CRP/ALB was positively correlated with CRP,ESR,and Mayo scores(rs=0.573,0.682,0.696,P<0.05).In the CD group,NLR was positively correlated with CRP,ESR,and CDAI scores(rs=0.288,0.353,0.482,P<0.05),and PLR was positively correlated with CRP,ESR,and CDAI scores(rs=0.352,0.441,0.384,P<0.05)),LMR was negatively correlated with CRP,ESR,and CDAI scores(rs=-0.309,-0.354,-0.391,P<0.05),and SII was positively correlated with CRP,ESR,and CDAI scores(rs=0.359,0.463,0.507,P<0.05),CRP/ALB was positively correlated with CRP,ESR and CDAI scores(rs=0.464,0.519,0.426,P<0.001).6.The predictive value of inflammation indexes for UC and CD disease activityThe ROC curve analysis results drawn with the modified Mayo score≥3 as the cut-off value showed that NLR,PLR,LMR,SII,and CRP/ALB have predictive value for UC disease activity(P<0.05).The ROC curve determines that the best cut-off value of NLR for predicting UC disease activity is 2.17(AUC is 0.697,sensitivity is 68.4%,specificity is 66.7%),and the best cut-off value of PLR is 105.77(AUC is 0.694,sensitivity is 85.0%,specificity is 66.7%),the best cut-off value of LMR is 5.92(AUC is 0.679,sensitivity is 50.0%,specificity is 89.5%),the best cut-off value of SII is 503.49(AUC is 0.677,sensitivity The sensitivity is 65.4%,the specificity is 66.7%),the best cut-off value of CRP/ALB is 0.14(AUC is 0.821,the sensitivity is 69.2%,the specificity is 83.3%),and the AUCs of NLR,PLR,LMR,and SII are all<0.70,low predictive value for UC disease activity,CRP/ALB has the highest predictive value for UC disease activity.Taking the Best Crohn’s disease activity index≥150 as the cut-off value,the ROC curve analysis results showed that NLR,PLR,LMR,SII,CRP/ALB have predictive value for CD disease activity(P<0.05).The ROC curve determines that the best cut-off value of NLR for predicting CD disease activity is 1.56(AUC is 0.858,sensitivity is 86.9%,specificity is 83.3%),and the best cut-off value of PLR is 110.39(AUC is 0.850,sensitivity is 90.2%,specificity is 83.3%),the best cut-off value of LMR is 4.65(AUC is 0.852,sensitivity is 83.3%,specificity is 83.6%),and the best cut-off value of SII is 486.83(AUC is 0.866,Sensitivity is 80.3%,specificity is 83.3%),the best cut-off value of CRP/ALB is 0.27(AUC is 0.776,sensitivity is 68.9%,specificity is 83.3%).The AUC of NLR,PLR,LMR,SII,CRP/ALB are both>0.75,which has a high predictive value for CD disease activity,and SII has the highest predictive value for CD disease activity.Conclusion1.NLR,PLR,SII,CRP/ALB were significantly increased in IBD,and LMR was significantly decreased in IBD.2.In the active stage of IBD,NLR,PLR,SII,CRP/ALB increased significantly,and increased with the severity of the disease,while LMR decreased significantly,and decreased with the severity of the disease.It can be used as a monitoring indicator of disease activity.3.CRP/ALB has the highest predictive value for UC disease activity.NLR,PLR,LMR,SII,CRP/ALB all show high clinical value in predicting CD disease activity,and SII has the highest predictive value. |
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