单核细胞与淋巴细胞比值联合T-SPOT.TB检测在涂阴肺结核诊断中的应用价值

Application Value of Monocyte-to-Lymphocyte Ratio Combined with T-SPOT.TB Test in Diagnosis of Smear-Negative Tuberculosis

目的:探讨单核细胞与淋巴细胞比值(MLR)联合结核感染T细胞斑点试验(T-SPOT.TB)检测在涂阴肺结核诊断中的应用价值。方法:选取2021年9月—2023年9月孝感市中心医院收治的疑似肺结核患者329例作为研究对象,均行MLR、T-SPOT.TB检测。统计涂阴肺结核的检出情况,以综合诊断结果为“金标准”,将受试者分为结核组与非结核组,比较两组单核细胞、淋巴细胞、MLR;绘制受试者操作特征(ROC)曲线,计算MLR诊断涂阴肺结核的最佳临界值;分析MLR、T-SPOT.TB检测及两者联合检测的诊断效能。结果:329例受试者综合诊断结果显示,涂阴肺结核患者157例。结核组单核细胞、MLR高于非结核组,淋巴细胞低于非结核组,差异有统计学意义(P<0.001)。ROC曲线分析显示,MLR诊断涂阴肺结核的ROC曲线下总面积为0.78,最佳临界值为0.30。MLR检测诊断涂阴肺结核的准确度、特异度、阳性预测值高于T-SPOT.TB检测、联合检测,联合检测诊断涂阴肺结核的灵敏度高于MLR检测、T-SPOT.TB检测,差异有统计学意义(P<0.05);不同检测方式诊断涂阴肺结核的阴性预测值比较,差异无统计学意义(P>0.05)。结论:MLR联合T-SPOT.TB检测对涂阴肺结核具有良好的辅助诊断作用,其中MLR检测的诊断准确度、特异度、阳性预测值较高,联合检测能够提高诊断灵敏度。

Objective:To explore the application value of monocyte-to-lymphocyte ratio(MLR)combined with T-cell spot test for tuberculosis infection(T-SPOT.TB)test in the diagnosis of smear-negative tuberculosis.Methods:A total of 329 suspected pulmonary tuberculosis patients who were admitted to Xiaogan Central Hospital from September 2021 to September 2023 were selected as the study subjects.All subjects received MLR and T-SPOT.TB test.The detection of smear-negative tuberculosis was counted.The comprehensive diagnosis results were taken as the"gold standard".The subjects were divided into tuberculosis group and non-tuberculosis group.Monocytes,lymphocytes and MLR in the two groups were compared.The receiver operating characteristic(ROC)curve was plotted.The optimal cut-off value of MLR in diagnosis of smear-negative tuberculosis was calculated.The diagnostic efficiency of MLR,T-SPOT.TB test and combined test(MLR+T-SPOT.TB)was analyzed.Results:The comprehensive diagnosis results of 329 subjects showed that,157 patients with smear-negative tuberculosis were diagnosed.The monocytes and MLR in the tuberculosis group were higher than those in the non-tuberculosis group,and the lymphocytes in the tuberculosis group were lower than those in the non-tuberculosis group,and the difference was statistically significant(P<0.001).The ROC curve analysis showed that,the total area under the ROC curve of MLR in diagnosis of smear-negative tuberculosis was 0.78,and the optimal cut-off value was 0.30.The accuracy,specificity and positive predictive value of MLR test in diagnosis of smear-negative tuberculosis were higher than those of T-SPOT.TB test and combined test,and the sensitivity of combined test in diagnosis of smear-negative tuberculosis was higher than that of MLR test and T-SPOT.TB test,and the difference was statistically significant(P<0.05);There was no significant difference in the negative predictive value of different test methods in the diagnosis of smear-negative tuberculosis(P>0.05).Conclusion:MLR combined with T-SPOT.TB test has a good auxiliary diagnostic effect for smear-negative tuberculosis,and the diagnostic accuracy,specificity and positive predictive value of MLR test are higher,and the combined test can improve the diagnostic sensitivity.