Red blood cell distribution width to platelet ratio levels in assessment of histologic severity in patients with primary biliary cholangitis
Red blood cell distribution width to platelet ratio levels in assessment of histologic severity in patients with primary biliary cholangitis
复制标题
红细胞分布宽度与血小板比率水平评估原发性胆汁性胆管炎患者的组织学严重程度
DOI：
10.1080/00365513.2018.1449011
复制
发表时间：
2018-01-01
影响因子：
2.1
通讯作者：
Sun, Chao
中科院分区：
文献类型：
--
作者：
Jiang, Xihui;Wang, Ya;Sun, Chao
目的探讨原发性胆管炎（PBC）患者的组织学严重程度与红细胞分布宽度与血小板比值（RPR）的关系。107例经肝活检证实且尚未接受过治疗的PBC患者被纳入作为主要和验证队列。组织学分期分为早期（Scheuer's stage 1和2）和晚期（Scheuer's stage 3和4）。从我们的数据库中回顾性收集了患者的总体人口统计学资料、临床表现、血液学检查和生化特征。比较两组患者RPR、天门冬氨酸氨基转移酶/血小板比值指数（APRI）、纤维化指数（FIB-4）、AST/ALT比值（AAR）。在主要队列的77例患者中，共有24例（31.2%）为早期PBC，而53例（68.8%）为晚期PBC。晚期PBC患者的红细胞分布宽度明显高于正常对照组（15.5 vs. 14.1%，p = 0.016），RPR（0.15 vs. 0.09，p < .001），直接胆红素（32.4 vs. 12.9 μmol/L，p = .041）、FIB-4（3.41 vs. 6.34，p = .001）和血小板显著降低（132.8 vs. 185.8 × 109/L，p = .002）。曲线下面积、临界值、敏感性、特异性、阳性预测值、阴性预测值分别为0.74、0.14、49.1%、95.8%、96.3%、46.0%。此外，高RPR也可作为18个月死亡率的预后指标。总之，RPR可作为PBC患者组织学严重程度的无创和有效的预测因子。
Abstract We aimed to investigate the relationship between the histologic severity and red blood cell distribution width to platelet ratio (RPR) in patients with primary biliary cholangitis (PBC). One hundred and seven consecutive patients with liver biopsy-proven and as yet treatment-naïve PBC were enrolled as the primary and validation cohort. The histologic stages were divided into early stage (Scheuer’s stage 1 & 2) and late stage (Scheuer’s stage 3 & 4). The overall patient demographics, clinical manifestations, hematological tests and biochemical profile were retrospectively collected from our database. Both groups were compared in terms of RPR, aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4) and AST/ALT ratio (AAR). Of the 77 patients in the primary cohort, a total of 24 (31.2%) had early stage PBC, whereas 53 (68.8%) represented late stage. Patients with late stage PBC showed significantly higher red blood cell distribution width (15.5 vs. 14.1%, p = .016), RPR (0.15 vs. 0.09, p < .001), direct bilirubin (32.4 vs. 12.9 μmol/L, p = .041), FIB-4 (3.41 vs. 6.34, p = .001) and significantly lower platelet (132.8 vs. 185.8 × 109/L, p = .002). The area under the curve, cut-off value, sensitivity, specificity, positive predictive value, negative predictive value for determining late stage were 0.74, 0.14, 49.1%, 95.8%, 96.3% and 46.0%, respectively. Additionally, high RPR may also serve as a prognostic indicator for 18-month mortality. In conclusion, RPR can be used as a non-invasive and effective predictor of histologic severity in patients with PBC.