| Background and objectiveSpondyloarthritis(SpA)is a group of inflammatory disorders that primarily affect the axial joints,which can be accompanied by peripheral arthritis and extra-articular manifestations.At late stages of the disease,SpA can result in spine fusion and ankylosis of the affected joints,which can affect the patient’s quality of life seriously.So it is vital to assess the disease activity and efficacy in SpA patients.Bath ankylosing spondylitis disease activity index(BASDAI),ankylosing spondylitis disease activity score(ASDAS),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and imaging examination were currently performed to assess the disease activity and efficacy of SpA patients,however,all of these approaches have their shortcomings.More easily accessible indicators for assessing the disease activity and efficacy of SpA patients are needed clinically.This study aims to explore the clinical significance of hematological indicators in SpA.MethodsA total of 304 SpA patients and 150 healthy controls were included in this study.In order to increase the credibility of the study results,SpA patients were divided into testing group(155 cases)(January 2015 to December 2017)and validation group(149 cases)(January 2018 to December 2020)according to the time of treatment.Clinical data of SpA patients were collected,and hematological indicators from SpA patients and healthy controls,including Systemic Inflammation Response Index(SIRI),Systemic Immune-Inflammation Index(SII),Neutrophil to Lymphocyte Ratio(NLR),Platelet to Lymphocyte Ratio(PLR),Monocyte to Lymphocyte Ratio(MLR),Hemoglobin to Red cell distribution width Ratio(HRR),Red cell distribution width to Platelet Ratio(RPR)and C-reactive protein to Albumin Ratio(CAR),were collected at baseline and after three months of non-steroid anti-inflammatory drugs(NSAIDs)treatment.Firstly,the differences of hematologic indicators between testing group,validation group and healthy controls were analyzed,respectively.The correlation between hematological indicators and acute reactants,and disease activity in testing group and validation group were analyzed,respectively.Then SpA patients were divided into low disease activity group defined as ASDAS-CRP<2.1 and high disease activity group defined as ASDAS-CRP≥2.1,and the differences of hematological indicators between the two groups were compared.Binary logistic multivariate regression analysis was conducted to explore the risk factors of high disease activity.Receiver operating characteristic(ROC)curve was used to evaluate the accuracy of hematological indicators to assess the activity of SpA.Afterwards,the differences of hematologic indicators before and after treatment with NSAIDs were compared.Meanwhile,the differences of hematologic indicators at baseline between remission group and active group after treatment with NSAIDs were also compared.The predictors of disease remission in SpA patients were analyzed by binary logistic multivariate regression analysis.Finally,ROC curve was performed to assess whether hematological indicators at baseline could be used to evaluate the efficacy of SpA patients after treatment with NSAIDs.Results1.There was no significant difference in clinical characteristics and hematological indicators between testing group and validation group(P>0.05).Compared with those in healthy controls,the levels of SIRI,SII,NLR,PLR and MLR in testing group were significantly increased(P<0.05),whereas the levels of HRR and RPR in the testing group were markedly decreased(P<0.05).The levels of SIRI,SII,NLR,PLR and MLR in validation group were significantly higher than those in healthy control group(P<0.05),whereas the levels of HRR and RPR in validation group were markedly lower than those in healthy control group(P<0.05).2.The levels of SIRI,SII,NLR,PLR,MLR and CAR were positively correlated with the levels of ESR,CRP and ASDAS-CRP in testing group,while the levels of HRR and RPR were negatively correlated with the levels of ESR,CRP and ASDAS-CRP in testing group.The levels of SIRI,SII,NLR,PLR and CAR were positively correlated with the levels of ESR,CRP and ASDAS-CRP in validation group,while the levels of HRR and RPR were negatively correlated with the levels of ESR,CRP and ASDAS-CRP in validation group.3.The levels of SIRI,SII,NLR,PLR,MLR and CAR in ASDAS-CRP≥2.1 group were significantly higher than those in ASDAS-CRP<2.1 group(P<0.05)in testing group,while the levels of HRR and RPR were significantly lower than those in the ASDAS-CRP<2.1 group(P<0.05)in testing group.Binary logistic multivariate regression analysis showed that CAR was an independent risk factor of disease activity in SpA patients(P<0.05).Meanwhile,in validation group,the levels of SIRI,SII,NLR,PLR,MLR and CAR in ASDAS-CRP≥2.1 group were significantly higher than those in ASDAS-CRP<2.1 group(P<0.05),while the levels of HRR and RPR were significantly lower than those in the ASDAS-CRP<2.1 group(P<0.05).Binary logistic multivariate regression analysis demonstrated that CAR was an independent risk factor of disease activity in SpA patients(P<0.05).ROC curve of both groups showed that SIRI,SII,NLR,PLR,MLR and CAR could be performed to evaluate the disease activity of SpA.4.After 3 months of treatment with NSAIDs,the levels of SIRI,SII,NLR,PLR,MLR and CAR in testing group were significantly decreased compared with treatment before(P<0.05),while the levels of HRR and RPR were significantly increased compared with treatment before(P<0.05).The levels of SIRI,SII,NLR,PLR,MLR and CAR in validation group were significantly decreased compared with treatment before(P<0.05),while the levels of HRR and RPR were significantly increased compared with treatment before(P<0.05).5.After 3 months of treatment with NSAIDs,the levels of SIRI,SII,NLR,PLR,MLR and CAR at baseline in inactive group were significantly lower than those in active group(P<0.05),and the levels of HRR and RPR at baseline were significantly higher than those in active group(P<0.05)in testing group.Binary logistic multivariate regression analysis showed that CAR was an independent predictor of disease remission in SpA patients after treatment with NSAIDs.The levels of SIRI,SII,NLR,PLR,MLR and CAR at baseline in inactive group were significantly lower than those in active group(P<0.05),and the levels of HRR and RPR at baseline were significantly higher than those in active group(P<0.05)in validation group.Binary logistic multivariate regression analysis showed that CAR was an independent predictor of disease remission in SpA patients after treatment with NSAIDs.ROC curve for both groups showed that the levels of SIRI,SII,NLR,PLR,MLR and CAR at baseline could be performed to evaluate the efficacy of SpA patients after treatment with NSAIDs.ConclusionThe levels of SIRI,SII,NLR,PLR,MLR and CAR are correlated with the levels of acute reactants and disease activity of SpA patients and could be performed to evaluate disease activity of SpA patients,while the level of CAR is an independent risk factor for high disease activity in SpA patients.The levels of SIRI,SII,NLR,PLR,MLR and CAR decreased significantly after treatment with NSAIDs.The levels of SIRI,SII,NLR,PLR,MLR and CAR at baseline could be performed to evaluate the efficacy of SpA patients after treatment with NSAIDs,and the level of CAR at baseline was an independent predictor of disease remission in SpA patients. |
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