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

Abstract

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

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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