Changes of NLR, PLR, MPVLR and SII levels in patients with immune checkpoint inhibitors-related myocarditis and their clinical significance
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摘要: 目的 分析免疫检查点抑制剂(ICIs)相关性心肌炎患者中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、平均血小板体积/淋巴细胞比值(MPVLR)和全身免疫炎症指数(SII)水平的变化，同时分析其对ICIs相关性心肌炎的诊断价值。方法 选取新疆医科大学附属肿瘤医院2020—2023年收治的因应用ICIs治疗导致心肌炎的肿瘤患者26例。收集患者的一般临床资料、血常规、超声心动图等指标，进一步计算NLR、PLR、MPVLR和SII；分析患者基线及病程中NLR、PLR、MPVLR、SII水平变化；ROC曲线分析病程中NLR、PLR、MPVLR和SII对ICIs相关性心肌炎的诊断价值。结果 26例患者中男性19例，女性7例，中位发病年龄为63岁。心电图及超声心动图表现多样。病程中NLR、PLR、MPVLR、SII值较基线均显著增高(均P < 0.05)。病程中NLR诊断ICIs相关性心肌炎的ROC曲线下面积(AUC)为0.710，PLR为0.621，MPVLR为0.686，SII为0.692。结论 NLR、PLR、MPVLR和SII可作为诊断ICIs相关性心肌炎的潜在标志物。
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关键词:
- 心肌炎 /
- 中性粒细胞/淋巴细胞比值 /
- 血小板/淋巴细胞比值 /
- 平均血小板体积/淋巴细胞比值 /
- 全身免疫炎症指数
Abstract: Objective To analyze the changes in the levels of neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), mean platelet volume-to-lymphocyte ratio(MPVLR), and systemic immune-inflammation index(SII) in patients with immune checkpoint inhibitors(ICIs) -related myocarditis and to evaluate their diagnostic value for ICIs-related myocarditis.Methods Twenty-six cancer patients who developed myocarditis due to treatment with ICIs, admitted to the Cancer Hospital Affiliated to Xinjiang Medical University from 2020 to 2023, were selected. General clinical data, complete blood counts, and echocardiography parameters were collected. NLR, PLR, MPVLR, and SII were calculated. Changes in the levels of NLR, PLR, MPVLR, and SII at baseline and during the disease course were analyzed. The diagnostic value of these indices during the disease course in ICIs-related myocarditis was evaluated using ROC curve analysis.Results Among the 26 patients, 19 were male, and 7 were female, with a median onset age of 63 years. Electrocardiogram(ECG) and echocardiography findings varied. During the disease course, the levels of NLR, PLR, MPVLR, and SII were significantly higher compared to baseline(all P < 0.05). The area under the ROC curve(AUC) for diagnosing ICIs-related myocarditis using NLR was 0.710, PLR was 0.621, MPVLR was 0.686, and SII was 0.692.Conclusion NLR, PLR, MPVLR, and SII may serve as potential biomarkers for the diagnosis of ICIs-related myocarditis. -
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图 1 NLR、PLR、MPVLR及SII诊断ICIs相关性心肌炎的ROC曲线
Figure 1. ROC curves for diagnosing ICIs-related myocarditis using NLR, PLR, MPVLR, and SII
表 1 纳入患者的临床基础特征
Table 1. Baseline characteristics of included patients
例(%), X ± S, M(P25, P75) 项目 数据 性别 男 19(73.10) 女 7(26.90) 年龄/岁 60.58±11.39 BMI/(kg/m2) 23.78±3.03 ≥18.5 kg/m2且 < 24.0 kg/m2 17(65.40) ≥24.0 kg/m2且 < 28.0 kg/m2 8(30.80) ≥28.0 kg/m2 1(3.80) 吸烟史 18(69.20) 既往病史 高血压 10(38.50) 糖尿病 7(26.90) 冠心病 3(11.50) 放疗史 2(7.70) 肿瘤类型 肺癌 20(76.90) 消化道肿瘤 4(15.40) 其他 2(7.70) ICIs类型 PD-1抑制剂 24(92.30) PD-L1抑制剂 2(7.70) ICIs治疗周期/次 2.00(1.00，3.00) ICIs治疗后出现心肌炎时间/d 30(19.00，40.50) ICIs分级 G1 2(7.70) G2 11(42.30) G3 8(30.80) G4 5(19.20) 合并其他免疫相关不良事件 甲状腺功能异常 8(30.80) 肌炎 2(7.70) 肝炎 4(15.40) 肝炎+肌炎 1(3.80) 首发症状 胸闷 13(50.00) 乏力 15(57.70) 心悸 2(7.70) 激素治疗 26(100.00) 死亡 2(7.70) 
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表 2 ICIs相关性心肌炎患者心肌损伤标志物及心电图特点
Table 2. Myocardial injury biomarkers and electrocardiogram characteristics in patients with ICIs-related myocarditis
例(%), X ± S, M(P25, P75) 项目 数据 心肌损伤标志物 CK-MB/(U/L) 29.00(15.90，120.50) cTnT/(ng/mL) 0.07(0.04，0.31) NT-proBNP/(pg/mL) 172.00(94.81，1 504.50) LVEF/% 64.17±3.47 心电图特点 窦性心动过速 5(19.20) 心房颤动 1(3.80) 室性期前收缩 3(11.50) 房性期前收缩 3(11.50) 交界性期前收缩 1(3.80) 束支传导阻滞 5(19.20) ST-T改变 9(34.60) T波低平 3(11.50) 异常Q波 3(11.50) CK-MB：肌酸激酶同工酶。
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表 3 NLR、PLR、MPVLR和SII水平
Table 3. NLR, PLR, MPVLR and SII levels
M(P25, P75) 项目 基线 病程中 Z P NLR 3.30(2.62，4.36) 9.26(3.97，16.03) -3.949 < 0.001 PLR 176.37(100.47，255.79) 205.29(88.90，397.45) -1.994 0.046 MPVLR 8.33(4.57，12.52) 11.78(5.57，19.42) -2.121 0.034 SII 624.02(337.17，1 123.48) 1 523.23(614.93，3 413.29) -3.619 < 0.001
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