中性粒细胞与淋巴细胞比值在肺结核诊断中价值分析

Neutrophil-lymphocyte count ratio in the diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia

目的分析中性粒细胞与淋巴细胞比值(NLCR)在肺结核诊断的临床价值,为肺结核早期诊断提供科学依据。方法回顾性分析2012-2014年就诊患者,抽取确诊肺结核患者(TB)和细菌性肺炎患者(CAP)各100例纳入研究,对其入院时血常规检测和超敏C反应蛋白(CRP)结果进行统计学分析比较。结果TB患者的NLCR水平显著低于细菌性CAP患者(4.95±3.12 vs 14.14±3.04 P<0.01),差异具有统计学意义。相关性分析结果:NLCR水平与中性粒细胞(r=0.846,P=0.01)、CRP(r=0.594,P=0.01)及白细胞总数(r=0.751,P=0.01)成正相关,与淋巴细胞(r=-0.618,P=0.01)呈负相关。诊断结核性的临界值是NLCR<7(敏感度为90.8%,特异度为82.3%,准确度为87.4%,阳性预测值为86.3%,阴性预测值为89.1%)。NLCR的ROC曲线下面积(AUC=0.93)显著高于CRP(AUC=0.82),P<0.01。结论 NLCR可以区分结核性与细菌性CAP,能作为肺结核早期诊断的实验室依据。

Objective To investigate the clinical value of NLCR for discriminating pulmonary TB from bacterial CAP,and to provide the scientific laboratory marker for early diagnosis of pulmonary TB.Methods We retrospectively analyzed the clinical and laboratory characteristics of 200 patients suspected with pulmonary TB or bacterial CAP from January 2012 to December 2014.The diagnostic ability of NLCR for differential diagnosis was evaluated and compared with that of C-reactive protein.Results The serum NLCR level was significantly lower in patients with pulmonary TB than in patients with bacterial CAP(4.95±3.12 vs 14.14±3.04,P<0.01).A NLCR<7 was an optimal cut-off value to discriminate patients with pulmonary TB from patients with bacterial CAP(sensitivity 90.8%,specificity 82.3%,positive predictive value 86.3%,negative predictive value 89.1%).The area under the curve for NLCR(0.93,95%CI,0.89-0.95)was significantly greater than that of C-reactive protein(0.82,95%CI,0.76-0.88;P<0.01).Conclusion The NLCR obtained at the initial diagnostic stage is a useful laboratory marker to discriminate patients with pulmonary TB from patients with bacterial CAP.