外周血NLR、MLR在老年肺结核患者预后评估中的价值

The value of peripheral blood NLR and MLR in the prognosis evaluation of elderly patients with pulmonary tuberculosis

目的探究外周血中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)在老年肺结核患者预后评估中的价值。方法选取2017年3月-2019年3月湖南省胸科医院收治的老年肺结核患者63例作为研究对象(结核组),入组患者治疗3个月时根据痰菌转阴情况分为痰菌阳性组24例和痰菌转阴组39例,另选取同期在本院体检显示健康者65人作为对照组。使用全自动血细胞分析仪检测患者外周血血小板计数、中性粒细胞计数、单核细胞计数、淋巴细胞计数、NLR、MLR水平,分析其与不良预后发生的关系。采用酶联免疫吸附(ELISA)法检测血清白蛋白及C反应蛋白(CRP)水平。结果结核组CRP水平、血小板计数、中性粒细胞计数、单核细胞计数及NLR、MLR水平均明显高于对照组(P<0.05),白蛋白水平、淋巴细胞计数明显低于对照组(P<0.05)。痰菌阳性组CRP水平、血小板计数、中性粒细胞计数、单核细胞计数及NLR、MLR水平均明显高于痰菌转阴组(P<0.05),白蛋白水平、淋巴细胞计数明显低于痰菌转阴组(P<0.05)。血小板计数、NLR、MLR升高均是影响老年肺结核患者不良预后发生的独立危险因素(P<0.05)。外周血NLR、MLR联合预测老年肺结核患者不良预后发生的曲线下面积为0.882(95%CI:0.820~0.943),敏感度为89.80%,特异度为79.60%。结论老年肺结核患者外周血NLR、MLR水平升高,与患者痰菌未转阴等不良预后发生密切相关,二者联合检测对患者预后评估价值较高。

Objective To explore the values of peripheral blood neutrophil/lymphocyte ratio(NLR) and monocyte/lymphocyte ratio(MLR) in the prognosis of elderly patients with pulmonary tuberculosis.Methods 63 elderly patients with pulmonary tuberculosis admitted to our hospital from March 2017 to March 2019 were selected as the study objects(tuberculosis group).The patients were divided into sputum positive group(24 cases) and sputum negative group(39 cases) according to the situation of sputum negative transformation at three months of treatment,and another 65 healthy people in our hospital at the same time were selected as the control group.The level of platelet count,neutrophil count,monocyte count,lymphocyte count,levels of NLR and MLR in patients’ peripheral blood were measured by automatic hematology analyzer,and their relationships with different prognosis were analyzed.Serum albumin and C-reactive protein(CRP) levels were detected by enzyme-linked immunosorbent assay(ELISA).Results The level of CRP,platelet count,neutrophil count,monocyte count,levels of NLR and MLR in tuberculosis group were significantly higher than those in the control group(P<0.05),and the levels of albumin and lymphocyte were significantly lower than those in the control group(P<0.05).The level of CRP,platelet count,neutrophil count,monocyte count,levels of NLR and MLR in sputum positive group were significantly higher than those in sputum negative group(P<0.05),and the levels of albumin and lymphocyte were significantly lower than those in sputum negative group(P<0.05).Platelet count,NLR and MLR were independent risk factors for the poor prognosis of elderly patients with pulmonary tuberculosis(P<0.05).The area under the curve for predicting the adverse prognosis of the elderly patients with pulmonary tuberculosis was 0.882(95%CI:0.820-0.943),the sensitivity was 89.80%,and the specificity was 79.60%.Conclusions The levels of NLR and MLR in the peripheral blood of the elderly patients with pulmonary tuberculosis were increased,which were closely related to the adverse prognosis of the patients,such as the sputum bacteria did not turn negative.The combined detection of NLR and MLR in the peripheral blood had high value in the prognosis evaluation of elderly patients with pulmonary tuberculosis.