Clinical Value Analysis Of Neutrophil To Lymphocyte Ratio In Neuromyelitis Optica Spectrum Disorders And Multiple Sclerosis

Objective: To analyze the difference of neutrophil to lymphocyte ratio(NLR)in multiple sclerosis(MS),neuromyelitis optica spectrum disorders(NMOSD)and healthy controls(HC),and discuss the clinical value of NLR in MS and NMOSD.Methods: Selected 40 MS patients and 59 NMOSD patients from the Department of Neurology,Shengjing Hospital Affiliated to China Medical University from January2016 to October 2022.Clinical data such as age,gender,blood biochemical test results,and Expanded disability status scale(EDSS)of all patients were collected.A total of 76 healthy subjects who were in the physical examination center during the same period and whose age and sex matched those of MS and NMOSD patients were selected as healthy contr ols(HC).Compare NLR level among MS,NMOSD and HC groups.For NMOSD patients,they were divided into different subgroups according to the presence or absence of enhancing lesions and aquaporin-4 antibody(AQP4-Ab)test results levels,and the differences in clinical data between different subgroups were compared.Logistic regression analysis was used to evaluate the risk factors for severe neurological impairment in NMOSD patients,and the clinical value of NLR in identifying severe neurological impairment in NMOSD was analyzed by Receiver-operating characteristic curve(ROC).For MS patients,they were divided into subgroups according to the presence or absence of enhancing lesions,and the differences in data between subgroups will be compared.Then explore the correlation between EDSS and other variables in MS patients by logistic regression analysis.P<0.05 was considered to be statistically different.When pairwise comparisons between three groups were performed,P<0.017 was considered statistically significant under Bonferroni correction.Results: NLR levels in NMOSD patients and MS patients were higher than those in HC group [2.30(1.78-4.27)vs 1.36(1.16-1.87),P<0.017;1.85(1.52-2.36)vs 1.36(1.16-1.87),P<0.017].Among NMOSD patients,AQP4-Ab-positive patients had higher NLR levels than AQP4-Ab-negative patients [2.58(2.01-4.95)vs 2.04(1.50-2.85),P<0.05].The NLR level of patients with enhancing lesions was significantly higher than that of patients without enhancing lesions [3.63(2.23-5.59)vs 2.13(1.72-3.38),P<0.05].And high NLR level may be a risk factor for severe neurological impairment in NMOSD patients[OR(95% CI)=55.849(1.034-3015.290),P<0.05].The area under the ROC curve(AUC)for NLR to identify severe neurological impairment in NMOSD was 0.756(95%CI:0.635-0.877,P<0.05),the best cut-off value was 3.32,and the sensitivity and specificity were 0.595 and 1.000,respectively.The NMOSD patients in the high NLR group(NLR>3.32)had significantly higher EDSS in the lower NLR group(NLR≤3.32)[5.11(3.71-6.38)vs 2.06(1.51-2.26),P<0.05].Univariate binary logistic regression analysis indicated that there was a correlation between NLR and EDSS in MS patients [OR(95%CI)=4.567(1.153-18.093),P<0.05].Conclusion: The level of inflammation is different among NMOSD,MS and HC.The level of NLR in NMOSD patients is related to the severity of the disease,and high NLR can indicate severe neurological deficits in NMOSD patients.NMOSD patients in the high NLR group may have more severe disease compared to NMOSD patients in the low NLR group.NLR levels correlate with disease severity in MS patients.