血小板/淋巴细胞比值、血小板/白细胞比值在活动性肺结核病情评估中的临床价值

Clinical value of platelet/lymphocyte ratio and platelet/leukocyte ratio in the evaluation of active pulmonary tuberculosis

目的研究血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)、血小板/白细胞比值(platelet/white blood cell ratio,PWR)在活动性肺结核病情评估中的临床价值。方法选取2018年12月至2021年12月徐州医科大学附属沭阳医院感染科活动性肺结核患者119例,并根据病情程度分为轻症肺结核(n=78)、重症肺结核(n=41),比较不同病情程度一般资料及PLR、PWR,采用Logistic回归分析病情程度的影响因素,采用受试者工作特征(receiver operating characteristics,ROC)曲线评估PLR、PWR对病情程度的评估价值。结果不同病情程度性别、年龄、体质量指数(body mass index,BMI)、结核类型、结核灶部位、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、治疗药物使用情况比较,差异无统计学意义(P>0.05);重症肺结核患者吸烟占比、合并肺部感染、红细胞沉降率(erythrocyte sedimentation rate,ESR)、降钙素原(procalcitonin,PCT)、超敏C反应蛋白(hypersensitive c-reactive protein,hs-CRP)高于轻症肺结核患者[78.05%比44.87%,31.71%比14.10%,(32.59±5.21)mm/h比(21.87±3.10)mm/h,(0.67±0.11)ng/mL比(0.54±0.10)ng/mL,(18.59±3.87)mg/L比(15.47±2.71)mg/L,t/χ^(2)值分别为12.02、5.17、14.07、6.51、5.13,P值均<0.05];重症肺结核PLR大于轻症肺结核,PWR小于轻症肺结核[(216.28±21.79)比(178.56±15.24),(8.92±1.85)比(14.57±2.24),t值分别为11.01和13.85,P值均<0.05];经Logistic回归分析,吸烟、合并肺部感染、PLR、PWR均为病情程度的影响因素(χ^(2)值分别为22.05、13.10、24.38、18.09,P值均<0.05);经ROC分析显示,PLR、PWR评估活动性肺结核患者病情程度的Cut-off值为195.69、10.25,AUC值为0.801、0.843,联合预测的AUC值为0.963。结论PLR、PWR对活动性肺结核病情具有较高评估价值,可作为临床重要参考指标。

Objective To study the clinical value of platelet/lymphocyte ratio(PLR)and platelet/leukocyte ratio(PWR)in the evaluation of active pulmonary tuberculosis.Methods From December 2018 to December 2021,119 patients with active pulmonary tuberculosis in the Department of infection of Shuyang Hospital Affiliated to Xuzhou Medical University were selected and divided into mild pulmonary tuberculosis(n=78)and severe pulmonary tuberculosis(n=41)according to the degree of illness.The general data of different degrees of illness,PLR and PWR were compared.Logistic regression was used to analyze the influencing factors of the degree of illness,and the working characteristics of subjects(ROC)was used to evaluate the evaluation value of PLR and PWR on the degree of illness.Results There was no significant difference in sex,age,Body mass index,type of tuberculosis,location of tuberculosis focus,systolic blood pressure,diastolic blood pressure and use of therapeutic drugs in different degrees of disease(P>0.05).The proportion of smoking,pulmonary infection,erythrocyte sedimentation rate,procalcitonin,hypersensitive C-reactive protein in severe pulmonary tuberculosis was higher than that in mild pulmonary tuberculosis[78.05%vs 44.87%,31.71%vs 14.10%,(32.59±5.21)mm/h vs(21.87±3.10)mm/h,(0.67±0.11)ng/mL vs(0.54±0.10)ng/mL,(18.59±3.87)mg/L vs(15.47±2.71)mg/L,t/χ^(2) values were 12.02,5.17,14.07,6.51,5.13,all P values<0.05].PLR of severe pulmonary tuberculosis was higher than that of mild pulmonary tuberculosis and PWR was lower than that of mild pulmonary tuberculosis[(216.28±21.79)vs(178.56±15.24),(8.92±1.85)vs(14.57±2.24),t values were 11.01 and 13.85,all P values<0.05].By logistic regression analysis,smoking,pulmonary infection,PLR and PWR were all the influencing factors of disease severity(χ^(2) values were 22.05,13.10,24.38,18.09,all P values<0.05).The ROC analysis showed that the cut-off values of PLR and PWR for assessing the severity of active pulmonary tuberculosis patients were 195.69 and 10.25,the AUC values were 0.801 and 0.843,and the combined predicted AUC value was 0.963.Conclusion PLR and PWR have high value in evaluating the status of active pulmonary tuberculosis and can be used as important clinical reference indexes.