Прогностическое и диагностическое значение показателя отношения нейтрофилов к лимфоцитам у пациентов с заболеваниями желудочно-кишечного тракта и печени

Цель данного обзора – провести анализ данных последних научных исследований, оценивающих диагностическую и прогностическую ценность показателя отношения нейтрофилов к лимфоцитам (ОНЛ) у пациентов с заболеваниями желудочно-кишечного тракта (ЖКТ) и печени. У пациентов с неалкогольной жировой болезнью печени (НАЖБП) повышенное значение показателя отношения нейтрофилов к лимфоцитам коррелировало со степенью выраженности фиброза и активностью заболевания, а также позволяло дифференцировать пациентов со стеатозом и неалкогольным стеатогепатитом (НАСГ).  У пациентов с циррозом печени ОНЛ показало свою прогностическую значимость в развитии летального исхода, сопоставимую со шкалами MELD и Child – Pugh, а в некоторых исследованиях даже превосходило их. Противоречивые данные получены в отношении его прогностической ценности в риске развития инфекционных осложнений у данной категории больных. У пациентов с болезнью Крона (БК) и язвенным колитом (ЯК) повышенное значение показателя ОНЛ ассоциировалось  с активностью заболевания. ОНЛ служит предиктором летального исхода и более тяжелого течения острого панкреатита. У пациентов с острым аппендицитом  ОНЛ показало свою диагностическую  значимость в выявлении его  тяжелых форм и прогностическую ценность в развитии летального исхода у пацинтов с онкологическими заболеваниями ЖКТ. ОНЛ служит маркером системного воспаления, который можно рассчитать с помощью параметров простого клинического анализа крови, что доступно в повседневной клинической практике. Ценность ОНЛ обусловлена его неинвазивностью и низкой стоимостью. Анализ литературы показал его прогностическую и диагностическую ценность при определенных заболеваниях ЖКТ и печени: чем выше значение исследуемого показателя, тем хуже прогноз, однако нет единого мнения относительно градации ОНЛ, а уровни отсечения колеблются в различных исследованиях. Также большинство работ носит ретроспективный характер, в связи с чем необходимо проведение крупных проспективных исследований в этом направлении.

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