泼尼松联合硫唑嘌呤治疗对自身免疫性肝炎患者NLR、LMR和PLR的影响及其与疾病活动性和治疗应答的关系

摘要/Abstract

摘要： 目的分析泼尼松联合硫唑嘌呤治疗对自身免疫性肝炎(AIH)患者中性粒细胞-淋巴细胞比值(NLR)、淋巴细胞-单核细胞比值(LMR)和血小板-淋巴细胞比值(PLR)的影响及其与疾病活动性和治疗应答的关系。方法纳入2022年6月至2024年6月我院收治的106例AIH患者(醋酸泼尼松联合硫唑嘌呤治疗6个月)和同期体检的106名健康者,比较两组NLR、LMR和PLR水平。采用受试者工作特征(ROC)曲线分析NLR、LMR、PLR对AIH患者疾病活动性和治疗应答的临床诊断价值。结果治疗前,AIH组NLR(3.4±1.1)和PLR(172.6±27.5)高于健康者[(1.1±0.3)和(83.4±11.3)],LMR(3.2±1.0)低于健康者(6.2±1.1);治疗后,AIH组NLR、PLR显著降低,而LMR显著升高(P<0.05)。入组时,缓解期组NLR(2.8±0.7)和PLR(151.3±26.7)低于活动期组[(4.2±0.9)和(203.8±31.5)],LMR(3.8±0.8)高于活动期组(2.5±0.6)(P<0.05)。治疗6个月后,AIH患者的应答率为56.60%,未应答或不完全应答率为43.40%。治疗应答组NLR(1.5±0.4)和PLR(100.8±20.6)低于未应答组[(4.1±0.6)和(183.9±25.2)],LMR(5.1±1.0)高于未应答组(3.8±0.9)(P<0.05)。NLR、LMR、PLR三项指标联合预测疾病活动性的曲线下面积(AUC)为0.981,灵敏度为89.4%,特异度为98.3%;三者联合预测治疗应答的AUC为0.975,灵敏度为93.5%,特异度为95.0%。结论泼尼松联合硫唑嘌呤可改善AIH患者NLR、LMR和PLR水平,这些指标与AIH的疾病活动性及治疗应答密切相关,可能参与疾病的发生与进展过程,值得进一步研究。

关键词: 泼尼松, 硫唑嘌呤, 自身免疫性肝炎, 疾病活动性, 治疗应答

Abstract: Objective To investigate the effects of prednisone combined with azathioprine on neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with autoimmune hepatitis (AIH), and to evaluate their associations with disease activity and treatment response. Methods A total of 106 patients with AIH and 106 healthy individuals were recruited in our hospital between June 2022 and June 2024. AIH patients received prednisone acetate combined with azathioprine for 6 months. NLR, LMR, and PLR levels were compared between the two groups. Receiver operating characteristic (ROC) curves were employed to assess the diagnostic value of these ratios for disease activity and treatment response. Results At baseline, NLR and PLR in AIH patients were (3.4±1.1) and (172.6±27.5), which were significantly higher than those of healthy individuals [(1.1±0.3) and (83.4±11.3), respectively (P<0.05)]. The LMR was (3.2±1.0), which was significantly lower than that of healthy individuals [(6.2±1.0), P<0.05]. Post-treatment, NLR and PLR significantly decreased, while LMR significantly increased in AIH patients (P<0.05). At enrollment, the NLR and PLR in the remission group were (2.8±0.7) and (151.3±26.7), which were significantly lower than those in the active disease group [(4.2±0.9) and (203.8±31.5), respectively]. The LMR in the remission group was (3.8±0.8), significantly higher than that in the active disease group [(2.5±0.6), P<0.05]. After 6 months of treatment, the response rate in AIH patients was 56.60%, while the non-response or partial response rate was 43.40%. The NLR and PLR in the response group were (1.5±0.4) and (100.8±20.6), significantly lower than those in the non-response group [(4.1±0.6) and (183.9±25.2), respectively], while the LMR was (5.1±1.0), significantly higher than that in the non-response group [(3.8±0.9), P<0.05]. ROC analysis showed that the area under the curve (AUC) for the combined prediction of disease activity by NLR, LMR and PLR was 0.981, with sensitivity of 89.4% and specificity of 98.3%. The AUC for the combined prediction of treatment response was 0.975, with sensitivity of 93.5% and specificity of 95.0%. Conclusion Prednisone combined with azathioprine effectively modulates NLR, LMR, and PLR levels in AIH patients. These ratios correlate closely with disease activity and therapeutic outcomes, indicating they may play a role in the development and progression of AIH, and warrant further investigation.

Key words: Prednisone, Azathioprine, Autoimmune hepatitis, Disease activity, Treatment response

张国强, 蔡红, 胡冰, 张慧影. 泼尼松联合硫唑嘌呤治疗对自身免疫性肝炎患者NLR、LMR和PLR的影响及其与疾病活动性和治疗应答的关系[J]. 肝脏, 2026, 31(1): 64-67.

ZHANG Guo-qiang, CAI Hong, HU Bing, ZHANG Hui-ying. Effects of prednisone combined with azathioprine on neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio in patients with autoimmune hepatitis and their correlation with disease activity and treatment response[J]. Chinese Hepatolgy, 2026, 31(1): 64-67.

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