Novel Prognostic Biomarkers of Mucosal Healing in Ulcerative Colitis Patients Treated With Anti-TNF: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio
Novel Prognostic Biomarkers of Mucosal Healing in Ulcerative Colitis Patients Treated With Anti-TNF: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio
复制标题
DOI：
10.1093/ibd/izaa062
复制
发表时间：
2020-10-01
影响因子：
4.9
通讯作者：
Costa, Francesco
中科院分区：
文献类型：
--
作者：
Bertani, Lorenzo;Rossari, Federico;Costa, Francesco
背景抗肿瘤坏死因子药物（抗TNF）广泛用于治疗溃疡性结肠炎（UC）。然而，许多患者在治疗的第一年就会失去反应。需要临床缓解和粘膜愈合的早期预测指标。中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率（PLR）是亚临床炎症的标志物，在接受抗 TNF 治疗的 UC 患者中评价较差。这项多中心研究的目的是评估NLR和PLR是否可以作为抗TNF治疗反应的预后标志物。方法对开始单药抗TNF治疗的UC患者进行评估。排除同时使用皮质类固醇治疗 >= 20 mg 的患者。我们在治疗前和诱导后计算了 NLR、PLR 和粪便钙卫蛋白。使用Mann-Whitney U检验将NLR和PLR值与随访结束时（54周）的临床缓解和粘膜愈合相关，然后进行多变量分析。结果纳入88例患者。治疗 54 周后达到粘膜愈合的患者的基线 NLR 和 PLR 水平较低（分别为 P = 0.0001 和 P = 0.04）；第 8 周获得了类似的结果（分别为 P = 0.0001 和 P = 0.001）。与未检测到溃疡的患者相比，基线内镜评估时出现活动性溃疡的患者具有更高的基线 NLR 和 PLR 值（分别为 P = 0.002 和 P = 0.0007）。 结论 NLR 和 PLR 作为 UC 患者抗 TNF 治疗治疗反应的早期预测因子具有良好的作用。如果在更大规模的研究中得到证实，本文提出的分类和回归树可能有助于指导有关抗 TNF 治疗的临床决策。
Background Anti-tumor necrosis factor drugs (anti-TNFs) are widely used for the treatment of ulcerative colitis (UC). However, many patients experience loss of response during the first year of therapy. An early predictor of clinical remission and mucosal healing is needed. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of subclinical inflammation poorly evaluated in UC patients treated with anti-TNFs. The aim of this multicenter study was to evaluate whether NLR and PLR could be used as prognostic markers of anti-TNF treatment response.Methods Patients with UC who started anti-TNF treatment in monotherapy were evaluated. Patients with concomitant corticosteroid treatment >= 20 mg were excluded. We calculated NLR, PLR, and fecal calprotectin before treatment and after induction. The values of NLR and PLR were correlated with clinical remission and mucosal healing at the end of follow-up (54 weeks) using the Mann-Whitney U test and then multivariate analysis was conducted.Results Eighty-eight patients were included. Patients who reached mucosal healing after 54 weeks of therapy displayed lower levels of both baseline NLR and PLR (P = 0.0001 and P = 0.04, respectively); similar results were obtained at week 8 (P = 0.0001 and P = 0.001, respectively). Patients who presented with active ulcers at baseline endoscopic evaluation had higher baseline NLR and PLR values compared with those without detected ulcers (P = 0.002 and P = 0.0007, respectively).Conclusions BothNLR and PLR showed a promising role as early predictors of therapeutic response to anti-TNF therapy in UC patients. If confirmed in larger studies, classification and regression trees proposed in this article could be useful to guide clinical decisions regarding anti-TNF treatment.