单核细胞与淋巴细胞比值联合SAT-TB法对于涂阴肺结核的鉴别诊断价值
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摘要
目的探讨单核/淋巴细胞比值(monocyte-to-lymphocyteratio,MLR)联合实时荧光恒温扩增检测技术(simultaneousisothermalAmplificationandTesting,SAT)对涂阴肺结核的预测及其对非结核性肺部疾患的鉴别诊断价值。方法选择来本院就诊的120例肺部疾病患者为研究对象,65例涂阴肺结核患者为实验组,55例非结核病患者为对照组,同时进行全血细胞计数和TBRNA检测,采用受试者工作曲线ROC对MLR截断值进行分析,计算两种方法及联合检测对于涂阴肺结核的检出灵敏度、特异度。结果与非结核病患者相比,涂阴肺结核患者外周血单核细胞数量、MLR值及T B-R N A阳性率均明显升高(P <0. 001)。受试者工作曲线(R O C)分析显示, M L R预测涂阴肺结核的灵敏度和特异度分别为61.5%、67.3%。与SAT-TB法联合应用的灵敏度、特异性、阴性预测值、阳性预测值分别为76.9%,67.3%,71.2%和73.5%,灵敏度明显高于MLR和SAT-TB法的单独应用,差异有统计学意义(P=0.043;P <0.001)。结论 MLR联合SAT-TB法对于涂阴肺结核有较好的预测和鉴别诊断价值,对控制结核病的传播具有一定意义。
Objective To investigate the predictive value of monocyte-to-lymphocyte ratio(MLR) combined with TB-RNA in smear-negative tuberculosis for differential diagnosis of pulmonary diseases. Methods One hundred and twenty patients with pulmonary diseases in the hospital were examined for blood cell counts and TB-RNA, among them included 65 smear-negative cases of pulmonary tuberculosis(experimental group) and 55 cases of non-tuberculosis(the control group). The cut-off value of MLR was analyzed by ROC curve, and the sensitivity and specificity of the two markers and the combined detection for smear-negative pulmonary tuberculosis were calculated. Results Compared with non-tuberculosis patients, the number of peripheral monocytes, MLR and positive rate of TB-RNA in the sputum samples of smear-negative pulmonary tuberculosis patients were significantly increased(P <0.001). The sensitivity and specificity of MLR in predicting smear-negative pulmonary tuberculosis were 61.5% and 67.3%, respectively. When combined with SAT-TB, the sensitivity,specificity, NPV and PPV were 76.9%, 67.3%, 71.2% and 73.5%, respectively. The combined sensitivity was notably higher than that of MLR and SAT-TB alone(P =0.043; P <0.001). Conclusion The MLR combined with SAT-TB has a promising predictive and differential diagnostic significance in smear-negative pulmonary tuberculosis, indicating a potential value in controlling the spread of tuberculosis.
Objective To investigate the predictive value of monocyte-to-lymphocyte ratio(MLR) combined with TB-RNA in smear-negative tuberculosis for differential diagnosis of pulmonary diseases. Methods One hundred and twenty patients with pulmonary diseases in the hospital were examined for blood cell counts and TB-RNA, among them included 65 smear-negative cases of pulmonary tuberculosis(experimental group) and 55 cases of non-tuberculosis(the control group). The cut-off value of MLR was analyzed by ROC curve, and the sensitivity and specificity of the two markers and the combined detection for smear-negative pulmonary tuberculosis were calculated. Results Compared with non-tuberculosis patients, the number of peripheral monocytes, MLR and positive rate of TB-RNA in the sputum samples of smear-negative pulmonary tuberculosis patients were significantly increased(P <0.001). The sensitivity and specificity of MLR in predicting smear-negative pulmonary tuberculosis were 61.5% and 67.3%, respectively. When combined with SAT-TB, the sensitivity,specificity, NPV and PPV were 76.9%, 67.3%, 71.2% and 73.5%, respectively. The combined sensitivity was notably higher than that of MLR and SAT-TB alone(P =0.043; P <0.001). Conclusion The MLR combined with SAT-TB has a promising predictive and differential diagnostic significance in smear-negative pulmonary tuberculosis, indicating a potential value in controlling the spread of tuberculosis.
引文
1黄飞,刘二勇,夏愔愔等.2005-2014年全国涂阴肺结核报告发病与死亡现状分析[J].中国防痨杂志,2015,37(5):473-477.
2刘建清,林秀华,沈志勇.淋巴细胞与单核细胞比值对晚期肺癌预后预测的价值[J].现代肿瘤医学,2018, 26(11):1706-1710.
3朱艺伟,姚明解,薄亚聪等.淋巴细胞与单核细胞比值对原发性肝癌患者根治性切除术后预后的预测价值[J].郑州大学学报(医学版),2017, 52(2):197-200.
4徐金良,杜丹丹,翟志敏等.卵巢良恶性肿瘤患者血液NLR, LMR, RDW, PLR四项参数的变化及其临床意义[J].现代检验医学杂志,2018, 33(2):16-22.
5李涵,李倩,曹增等.外周血淋巴细胞和单核细胞计数及其比值对初治多发性骨髓瘤患者预后的预测价值[J].肿瘤,2017, 37(8):865-872.
6 Wendi Li, Lianyuan Tao, Lingfu Zhang, et al.Prognostic role of lymphocyte to monocyte ratio for patients with pancreatic cancer:a systematic review and meta-analysis[J]. Onco Targets Ther, 2017,10(7):3391-3397.
7 Vivek Naranbhai, Adrian V. S. Hill, Salim S. Abdool Karim, et al. Ratio of Monocytes to Lymphocytes in Peripheral Blood Identifies Adults at Risk of Incident Tuberculosis Among HIV-Infected Adults Initiating Antiretroviral Therapy[J]. J Infect Dis, 2014, 209(4):500-509.
8 Sumaira Iqbal, Umbreen Ahmed, Syed Badshah Hussain Zaidi. Monocyte Lymphocyte Ratio as a Possible Prognostic Marker in Antituberculous Therapy[J].JRMC, 2014, 18(2):178-181.
9 Jun Wang, Yongmei Yin, Xuedong Wang, et al. Ratioof monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis[J]. Brazil J Infect Dis, 2015, 19(2):125-131.
10许蕴怡,蔡杏珊,谭耀驹等.SAT-TB检测支气管肺泡灌洗液对涂阴肺结核的快速临床诊断价值[J].现代医院,2018, 18(2):298-300.
11范琳,王鹏,杨妍等.RNA恒温扩增实时荧光检测技术检测支气管肺泡灌洗液对涂阴肺结核的快速诊断价值[J].中国防痨杂志.2015, 37(2):140-144.
12 Liping Yan, Qing Zhang, Heping Xiao. Clinical diagnostic value of simultaneous amplification and testing for the diagnosis of sputum-scarce pulmonary tuberculosis[J]. Bmc Infect Dis, 2017, 17(1):545-551.
13 Lin Fan, Danfeng Li, Shaojun Zhang, et al. Parallel Tests Using Culture, Xpert MTB/RIF, and SATTB in Sputum Plus Bronchial Alveolar Lavage Fluid Significantly Increase DiagnosticPerformance of SmearNegative Pulmonary Tuberculosis[J]. Front Microbiol,2018, 9(1107):1-7.
14 Yiwen Chen, Lahong Zhang, Liquan Hong, et al. Rapid diagnosis of pulmonary tuberculosis and detection of drug resistance by combined simultaneous amplification testing and reverse dot blot[J]. J Clin Pathol, 2017, 71(6):498-503.
15许蕴怡,蔡杏珊,谭耀驹等.SAT技术检测结核杆菌rRNA对肺结核的快速诊断价值[J].实用医学杂志,2018, 34(2):297-300.
16 Matthias Engele, Elmar Stoβel, Kirstin Castiglione, et al. Induction of TNF in Human Alveolar Macrophages As a Potential Evasion Mechanism of Virulent Mycobacterium tuberculosis[J]. J Immunol,2002, 168(3):1328-1337.
17汪毅平,刘真,张亚洁等.结核性创面大鼠模型中巨噬细胞极化改变[J].中华损伤与修复杂志(电子版),2018, 13(1):30-36.
18伏开新,王绪山,乔以凤.单核细胞/淋巴细胞比值在活动性结核感染诊断中的应用价值[J].中国卫生检验杂志,2017, 27(19):2805-2808.
19 MPL Manna, V Orlando, F Dieli, et al. Quantitative and qualitative profiles of circulating monocytes may help identifying tuberculosis infection and disease stages[J].Plos One. 2017, 12(2):e0171358.
2刘建清,林秀华,沈志勇.淋巴细胞与单核细胞比值对晚期肺癌预后预测的价值[J].现代肿瘤医学,2018, 26(11):1706-1710.
3朱艺伟,姚明解,薄亚聪等.淋巴细胞与单核细胞比值对原发性肝癌患者根治性切除术后预后的预测价值[J].郑州大学学报(医学版),2017, 52(2):197-200.
4徐金良,杜丹丹,翟志敏等.卵巢良恶性肿瘤患者血液NLR, LMR, RDW, PLR四项参数的变化及其临床意义[J].现代检验医学杂志,2018, 33(2):16-22.
5李涵,李倩,曹增等.外周血淋巴细胞和单核细胞计数及其比值对初治多发性骨髓瘤患者预后的预测价值[J].肿瘤,2017, 37(8):865-872.
6 Wendi Li, Lianyuan Tao, Lingfu Zhang, et al.Prognostic role of lymphocyte to monocyte ratio for patients with pancreatic cancer:a systematic review and meta-analysis[J]. Onco Targets Ther, 2017,10(7):3391-3397.
7 Vivek Naranbhai, Adrian V. S. Hill, Salim S. Abdool Karim, et al. Ratio of Monocytes to Lymphocytes in Peripheral Blood Identifies Adults at Risk of Incident Tuberculosis Among HIV-Infected Adults Initiating Antiretroviral Therapy[J]. J Infect Dis, 2014, 209(4):500-509.
8 Sumaira Iqbal, Umbreen Ahmed, Syed Badshah Hussain Zaidi. Monocyte Lymphocyte Ratio as a Possible Prognostic Marker in Antituberculous Therapy[J].JRMC, 2014, 18(2):178-181.
9 Jun Wang, Yongmei Yin, Xuedong Wang, et al. Ratioof monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis[J]. Brazil J Infect Dis, 2015, 19(2):125-131.
10许蕴怡,蔡杏珊,谭耀驹等.SAT-TB检测支气管肺泡灌洗液对涂阴肺结核的快速临床诊断价值[J].现代医院,2018, 18(2):298-300.
11范琳,王鹏,杨妍等.RNA恒温扩增实时荧光检测技术检测支气管肺泡灌洗液对涂阴肺结核的快速诊断价值[J].中国防痨杂志.2015, 37(2):140-144.
12 Liping Yan, Qing Zhang, Heping Xiao. Clinical diagnostic value of simultaneous amplification and testing for the diagnosis of sputum-scarce pulmonary tuberculosis[J]. Bmc Infect Dis, 2017, 17(1):545-551.
13 Lin Fan, Danfeng Li, Shaojun Zhang, et al. Parallel Tests Using Culture, Xpert MTB/RIF, and SATTB in Sputum Plus Bronchial Alveolar Lavage Fluid Significantly Increase DiagnosticPerformance of SmearNegative Pulmonary Tuberculosis[J]. Front Microbiol,2018, 9(1107):1-7.
14 Yiwen Chen, Lahong Zhang, Liquan Hong, et al. Rapid diagnosis of pulmonary tuberculosis and detection of drug resistance by combined simultaneous amplification testing and reverse dot blot[J]. J Clin Pathol, 2017, 71(6):498-503.
15许蕴怡,蔡杏珊,谭耀驹等.SAT技术检测结核杆菌rRNA对肺结核的快速诊断价值[J].实用医学杂志,2018, 34(2):297-300.
16 Matthias Engele, Elmar Stoβel, Kirstin Castiglione, et al. Induction of TNF in Human Alveolar Macrophages As a Potential Evasion Mechanism of Virulent Mycobacterium tuberculosis[J]. J Immunol,2002, 168(3):1328-1337.
17汪毅平,刘真,张亚洁等.结核性创面大鼠模型中巨噬细胞极化改变[J].中华损伤与修复杂志(电子版),2018, 13(1):30-36.
18伏开新,王绪山,乔以凤.单核细胞/淋巴细胞比值在活动性结核感染诊断中的应用价值[J].中国卫生检验杂志,2017, 27(19):2805-2808.
19 MPL Manna, V Orlando, F Dieli, et al. Quantitative and qualitative profiles of circulating monocytes may help identifying tuberculosis infection and disease stages[J].Plos One. 2017, 12(2):e0171358.