单核细胞与淋巴细胞比值及预后营养指数对菌阴肺结核的辅助诊断价值

The diagnostic value of MLR and PNI for smear-negative pulmonary tuberculosis

摘要:

目的 评价单核细胞与淋巴细胞比值（MLR）及预后营养指数（PNI）对菌阴肺结核的辅助诊断价值。方法 选取2020年5月—2021年4月青海大学附属医院疑似菌阴肺结核的患者129例。以最终确诊的菌阴肺结核患者53例作为病例组，非结核性肺部感染患者76例作为对照组；比较两组患者MLR、PNI、白蛋白等相关指标；绘制受试者工作特征（ROC）曲线评估MLR、PNI单独及联合检测在诊断菌阴肺结核的诊断效能。结果 两组患者性别、年龄、BMI和PCT水平比较，差异无统计学意义（P >0.05）。病例组CRP、中性粒细胞、单核细胞、血沉、FIB及MLR表达量高于对照组（P <0.05），前白蛋白、白蛋白、淋巴细胞及PNI表达量低于对照组（P <0.05）。MLR、PNI及两者联合诊断菌阴肺结核的ROC曲线下面积为0.873、0.859、0.917（P <0.05）。MLR诊断菌阴肺结核的敏感性及特异性分别为83.02%（95% CI：0.708，0.908）、78.95%（95% CI：0.685，0.866）；PNI诊断菌阴肺结核的敏感性及特异性分别为90.57%（95% CI：0.798，0.959）、73.68%（95% CI：0.628，0.823）；两者联合检测诊断菌肺结核的敏感性及特异性分别为84.91%（95% CI：0.730，0.922）、89.47%（95% CI：0.806，0.948）。MLR、PNI联合检测的AUC值大于PNI（P <0.05），但其与MLR比较，差异无统计学意义（P >0.05）。结论 MLR、PNI及其联合检测对菌阴肺结核的辅助诊断具有一定的价值，且联合诊断价值更高。

Abstract:

Objective To determine the value of monocyte-to-lymphocyte ratio (MLR) and prognostic nutritional index (PNI) in the diagnosis of smear-negative pulmonary tuberculosis.Methods A total of 129 patients with suspected smear-negative pulmonary tuberculosis in our hospital from May 2020 to April 2021 were selected. The 53 patients with finally confirmed pulmonary tuberculosis were included into the case group, and the 76 patients with non-tuberculous pulmonary infections were set as the control group. The MLR, PNI, albumin and other related indicators were compared between the two groups of patients. The receiver operating characteristic (ROC) curve was used to evaluate the specificity and sensitivity of MLR, PNI and their combined detection in the diagnosis of smear-negative pulmonary tuberculosis, and the diagnostic efficacy was compared between the two groups.Results There was no difference in the sex ratio, age, BMI and the level of PCT (P >0.05). The neutrophil and monocyte count, the levels of CRP, erythrocyte sedimentation rate and FIB, and MLR were higher in the case group than those in the control group (P < 0.05). The levels of prealbumin and albumin, lymphocyte count, and PNI were lower in the case group than those in the control group (P < 0.05). The area under the ROC curve (AUC) of MLR, PNI and their combined detection for the diagnosis of smear-negative pulmonary tuberculosis were 0.873, 0.859 and 0.917 (P < 0.05). The sensitivity and specificity of MLR for the diagnosis of smear-negative pulmonary tuberculosis were 83.02% (95% CI: 70.77%, 90.80%) and 78.95% (95% CI: 68.50%, 86.60%), while the sensitivity and specificity of PNI for the diagnosis of smear-negative pulmonary tuberculosis were 90.57% (95% CI:79.75%, 95.90%) and 73.68% (95% CI: 62.82%, 82.27%). Besides, the sensitivity and specificity of the combined detection of the two indicators for the diagnosis of smear-negative pulmonary tuberculosis were 84.91% (95% CI: 72.95%, 92.15%) and 89.47% (95% CI:80.58%, 94.75%). The AUC of the combined detection of MLR and PNI was greater than that of PNI alone (P < 0.05), but was not different from that of MLR alone for the diagnosis of smear-negative pulmonary tuberculosis (P > 0.05).Conclusions MLR, PNI and their combined detection are of certain value in the diagnosis of smear-negative pulmonary tuberculosis, and the combined detection of MLR and PNI exhibits greater diagnostic efficacy.