中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对老年肺结核患者合并肺部细菌感染的诊断价值

Diagnostic value of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in elderly patients of pulmonary tuberculosis complicated with pulmonary bacterial infection

目的探讨中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)在老年肺结核合并肺部细菌感染诊断中的应用价值。方法选取安徽省胸科医院2020年1—12月收治的老年肺结核患者248例,根据患者在院期间是否继发肺部细菌感染分为感染组及非感染组。比较2组患者住院时间、白细胞计数(WBC)、中性粒细胞计数、淋巴细胞计数、血小板计数(PLT)、NLR及PLR。采用受试者工作特征曲线和曲线下面积(AUC)分析各指标对老年肺结核患者合并肺部细菌感染的诊断效能。结果感染组住院时间长于非感染组,差异有统计学意义(P<0.001)。感染组WBC、中性粒细胞计数、NLR及PLR均高于非感染组,淋巴细胞计数低于非感染组,差异均有统计学意义(均P<0.05)。在WBC正常患者中,NLR、中性粒细胞计数、PLR、PLT诊断老年肺结核患者合并肺部细菌感染的AUC分别为0.665、0.655、0.602及0.541,敏感度分别为49.1%、78.9%、19.3%及47.4%,特异度分别为82.1%、47.2%、97.2%及63.2%。在淋巴细胞计数降低患者中,NLR、PLR、中性粒细胞计数、PLT诊断老年肺结核患者合并肺部细菌感染的AUC分别为0.800、0.629、0.771及0.565,敏感度分别为83.8%、35.1%、71.6%及78.4%,特异度分别为66.0%、91.5%、72.3%及38.3%。结论NLR、PLR对老年肺结核合并肺部细菌感染,特别是WBC正常、淋巴细胞计数降低的患者,具有一定诊断价值。

Objective To explore the application value of neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)in the diagnosis of elderly patients of pulmonary tuberculosis complicated with pulmonary bacterial infection.Methods From January to December 2020,248 elderly patients with tuberculosis admitted to Anhui Chest Hospital were selected.They were divided into infection group and non-infection group according to whether they had secondary pulmonary bacterial infection during the hospital.The length of stay,white blood cell count(WBC),neutrophil count,lymphocyte count,platelet count(PLT),NLR and PLR were compared between the two groups.Receiver operationg characteristic curve and the area under the curve(AUC)were used to analyze the diagnostic efficacy of various indicators in elderly patients with pulmonary tuberculosis complicated with pulmonary bacterial infection.Results The length of stay in the infection group was longer than that in the non-infection group(P<0.001).The WBC,neutrophil count,NLR,and PLR in the infection group were higher than those in the non-infection group,and the lymphocyte count was lower than that in the non-infection group(all P<0.05).Among the patients with normal WBC,the AUC of NLR,neutrophil count,PLR and PLT in the diagnosis of elderly pulmonary tuberculosis complicated with pulmonary bacterial infection were 0.665,0.655,0.602 and 0.541 respectively,the sensitivities were 49.1%,78.9%,19.3%and 47.4%respectively,and the specificities were 82.1%,47.2%,97.2%and 63.2%respectively.In patients with decreased lymphocyte count,the AUC of NLR,PLR,neutrophil count and PLT in the diagnosis of elderly pulmonary tuberculosis complicated with pulmonary bacterial infection were 0.800,0.629,0.771 and 0.565 respectively,the sensitivities were 83.8%,35.1%,71.6%and 78.4%respectively,and the specificities were 66.0%,91.5%,72.3%and 38.3%respectively.Conclusion NLR and PLR have certain diagnostic value for elderly pulmonary tuberculosis complicated with pulmonary bacterial infection,especially in the patients with normal WBC and decreased lymphocyte count.