切换至 "中华医学电子期刊资源库"

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (06) : 913 -919. doi: 10.3877/cma.j.issn.1674-6902.2024.06.011

论著

肺结核强化期治疗血液学特征的临床意义
陈兰1, 沈艳,1, 金柯1, 史萍1, 邓露茜1, 石丽萍1   
  1. 1.210000 南京,南京医科大学第一附属医院(江苏省人民医院)感染病科ICU
  • 收稿日期:2024-03-23 出版日期:2024-12-25
  • 通信作者: 沈艳
  • 基金资助:
    江苏省自然科学基金青年项目(SBK2020040678)

Clinical significance of hematological features after intensive treatment of pulmonary tuberculosis

Lan Chen1, Yan Shen,1, Ke Jin1, Ping Shi1, Luqian Deng1, Liping Shi1   

  1. 1.epartment of Infectious Diseases ICU, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial People's Hospital, Nanjing 210000,China
  • Received:2024-03-23 Published:2024-12-25
  • Corresponding author: Yan Shen
引用本文:

陈兰, 沈艳, 金柯, 史萍, 邓露茜, 石丽萍. 肺结核强化期治疗血液学特征的临床意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 913-919.

Lan Chen, Yan Shen, Ke Jin, Ping Shi, Luqian Deng, Liping Shi. Clinical significance of hematological features after intensive treatment of pulmonary tuberculosis[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(06): 913-919.

目的

分析肺结核(pulmonary tuberculosis,PTB)强化期治疗后血液学特征的意义。

方法

选择2020 年5 月至2022 年6 月我院收治的162 例新诊断PTB 患者为对象。 经2 个月强化期治疗后痰涂片镜检和痰培养转阴112 例为对照组,未转阴50 例为观察组。 检测24 种血液学参数。 采用血液学参数联合模型预测。

结果

观察组治疗后中性粒细胞计数(neutrophil,NEU)4.92(3.73,6.57)×109/L、单核细胞计数(monocyte,MONO)0.50(0.32,0.72)×109/L、单核细胞与淋巴细胞比值(MLR)0.23(0.16,0.34)、血小板与淋巴细胞比值(PLR)142.10(82.60,184.00)、中性粒细胞与淋巴细胞比值(NLR)2.29(1.57,3.05)、系统免疫炎症指数(systemic immunoinflammatory index,SII)568.60(361.90,1 018.60)、血小板计数(platelet count,PLT)296.00(201.00,390.00)×109/L、血小板压积(plateletcrit,PCT)0.15(0.13,0.19)mg/L、红细胞沉降率(erythrocyte sedimentation rate,ESR)45.00(25.00,85.00)mm/1 h、C 反应蛋白(C-reactive protein,CRP)9.30(9.10,11.30)mg/L 高于对照组6.02(4.76,7.52)×109/L、 0.89(0.47,1.08)×109/L、0.43(0.25,0.59)、155.50(102.60,193.90)、2.88(2.23,4.17)、735.40(575.20,1 110.50)、259.00(225.00,280.00)×109/L、 0.18(0.14,0.25)mg/L、 75.00(56.00,95.00)mm/1 h、 9.70(9.10,11.60)mg/L,观察组红细胞压积(hematocrit,HCT)42.30(39.10,45.90)%低于对照组38.20(35.20,40.40)%(P<0.05)。 治疗后对照组白细胞计数(white blood cell count,WBC)、NEU、MONO、MLR、NLR、PLR、SII、PLT、MPV、PCT、ESR、CRP 降低,红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)、HCT 升高(P<0.05);观察组治疗后NEU、NLR、MPV、ESR、CRP 降低,RBC、HCT、RDW-SD 升高(P<0.05)。 ROC曲线分析显示,治疗后单独血液学参数指标预测痰未转阴曲线下面积(area under the curve,AUC)<0.75。 Logistic 回归联合模型AUC 高于单个血液学参数(P<0.05)。 模型6(NEU、MLR、NLR、PLR、SII、HCT、PCT、ESR、CRP)的准确性,预测AUC 为0.852(95%CI:0.787~0.917)。

结论

血液学参数联合模型预测PTB 强化期治疗,具有临床意义。

Objective

To analyze value of hematological features after intensive treatment of pulmonary tuberculosis (PTB).

Methods

All of 162 newly diagnosed PTB patients admitted to our hospital from May 2020 to June 2022 were selected as subjects.After 2 months of intensive treatment,112 patients with negative sputum were included in the control group by smear microscopy and sputum culture,and 50 cases without negative sputum were included in the observation group.Peripheral venous blood was collected before and after anti-tuberculosis treatment,and 24 kinds of hematological parameters were detected.

Results

After treatment,neutrophils count [NEU,4.92 (3.73,6.57) ×109/L vs. 6.02(4.76,7.52) ×109/L] and monocytes count[MONO,0.50 (0.32,0.72) ×109/L vs. 0.89(0.47,1.08) ×109/L],monocyte to lymphocyte ratio [MLR,0.23 (0.16,0.34) vs. 0.43 (0.25,0.59)],platelet to lymphocyte ratio [PLR,142.10 (82.60,184.00) vs. 155.50 (102.60,193.90)],neutrophil to lymphocyte ratio [NLR,2.29 (1.57,3.05) vs.2.88(2.23,4.17)],systemic immunoinflammatory index [SII,568.60 (361.90,1 018.60) vs. 735.40 (575.20,1 110.50)],platelet count [PLT,296.00 (201.00,390.00)×109/L vs. 259.00 (225.00,280.00)×109/L],platelet [PCT,0.15 (0.13,0.19) vs. 0.18 (0.14,0.25)],erythrocyte sedimentation rate [ESR,45.00(25.00,85.00)mm/1 h vs. 75.00 (56.00,95.00)mm/1 h] and C-reactive protein [CRP,9.30 (9.10,11.30) mg/L vs. 9.70 (9.10,11.60)mg/L] were significantly higher than those in group.Hematocrit [HCT,42.30 (39.10,45.90) % vs. 38.20 (35.20,40.40)%] was significantly lower than that in sputum conversion to Yin group (P<0.05).Compared with before treatment,white blood cell count (WBC),NEU,MONO,MLR,NLR,PLR,SII,PLT,MPV,PCT,ESR and CRP were significantly decreased,while red blood cell count (RBC),hemoglobin (Hb) and HCT were significantly increased in the control group after treatment (P<0.05).In the observation group,NEU,NLR,MPV,ESR and CRP were significantly decreased after treatment,while RBC,HCT and RDW-SD were significantly increased (P<0.05).ROC curve was used to evaluate the predictive value of a single indicator for sputum not turning negative after treatment,and the results showed that the area under the prediction curve (AUC) of a single hematology parameter was<0.75.Logistic regression was used to construct the combined model,and the AUC of each model was significantly higher than that of a single hematology parameter (P<0.05).Model 6 (NEU,MLR,NLR,PLR,SII,HCT,PCT,ESR,CRP) had good accuracy and predicted an AUC of 0.852 (95%CI:0.787 ~0.917).

Conclusion

The combined model of hematology parameters can be used as a noninvasive prognostic tool for the outcome of PTB intensive treatment.

表1 两组肺结核治疗前血液学参数患者比较[n(%),M(M25,M75)]
血液学参数 对照组(n=112) 观察组(n=50) χ2/Z P
WBC(×109/L) 10.68(8.48,13.64) 9.00(7.00,10.90) -1.647 0.100
LYM(×109/L) 1.81(1.49,2.58) 1.99(1.33,2.40) -0.660 0.509
NEU(×109/L) 7.21(5.36,9.29) 7.13(5.21,9.38) -0.215 0.830
MONO(×109/L) 0.66(0.50,1.19) 0.59(0.45,0.79) -1.703 0.089
MLR 0.36(0.26,0.56) 0.28(0.21,0.45) -1.336 0.182
NLR 3.48(2.52,5.67) 3.95(2.84,5.00) -1.124 0.261
PLR 170.90(120.80,236.90) 136.60(90.90,182.20) -0.565 0.572
SII 1 271.20(680.90,2 259.20) 932.80(572.80,1 383.30) -0.590 0.555
RBC(%) 4.10(3.79,4.75) 4.33(3.90,4.85) -1.249 0.212
HGB(g/L) 125.00(107.00,133.00) 129.00(116.00,140.00) -0.190 0.849
HCT(%) 38.50(33.50,41.10) 38.10(35.10,40.80) -0.783 0.434
MCV(fL) 89.30(84.00,96.00) 90.30(86.00,96.50) -1.346 0.178
MCH(pg) 28.80(27.20,32.30) 31.00(27.90,34.00) -0.037 0.971
MCHC(g/L) 330.00(316.00,337.00) 331.00(322.00,351.00) -0.060 0.952
RDW-CV(%) 15.00(13.60,17.00) 14.00(13.00,15.80) -0.290 0.772
RDW-SD(fL) 42.80(39.40,46.80) 42.10(39.50,46.50) -1.311 0.190
PLT(×109/L) 355.00(241.00,515.00) 243.00(187.00,317.00) -1.587 0.112
PDW-CV(%) 38.90(38.50,39.20) 39.10(38.20,41.70) -0.122 0.903
PDW-SD(fL) 17.90(16.00,20.60) 17.60(15.00,20.60) -0.123 0.902
MPV(fL) 6.60(5.50,8.20) 8.00(6.80,9.50) -0.593 0.553
PCT(%) 0.21(0.16,0.29) 0.17(0.14,0.26) -0.800 0.423
P-LCR 23.88(21.07,30.02) 29.70(24.25,33.70) -1.206 0.228
ESR(mm/1 h) 83.00(60.00,100.00) 77.00(59.00,93.00) -0.153 0.878
CRP(mg/L) 16.30(11.20,17.90) 12.40(9.30,18.50) -1.095 0.274
表2 两组肺结核患者治疗后血液学参数结果比较
血液学参数 对照组(n=112) 观察组(n=50) Z P
WBC(×109/L) 7.39(6.20,9.80)a 8.37(6.95,9.73) -1.196 0.232
NEU(×109/L) 4.92(3.73,6.57)a 6.02(4.76,7.52)b -2.756 0.006
MONO(×109/L) 0.50(0.32,0.72)a 0.89(0.47,1.08) -2.037 0.042
MLR 0.23(0.16,0.34)a 0.43(0.25,0.59) -4.291 0.000
NLR 2.29(1.57,3.05)a 2.88(2.23,4.17)b -2.530 0.011
PLR 142.10(82.60,184.00)a 155.50(102.60,193.90) -2.348 0.019
SII 568.60(361.90,1 018.60)a 735.40(575.20,1 110.50) -3.517 0.000
RBC(%) 4.49(4.16,5.00)a 4.49(4.18,5.08)b -1.019 0.308
HGB(g/L) 128.00(120.00,145.00)a 124.00(104.00,135.00) -1.183 0.237
HCT(%) 42.30(39.10,45.90)a 38.20(35.20,40.40)b -2.144 0.032
MCV(fL) 87.50(83.90,92.40) 92.30(84.90,96.00) -0.640 0.522
MCH(pg) 29.00(27.30,30.60) 32.40(28.00,34.10) -0.137 0.891
MCHC(g/L) 329.00(318.00,335.00) 340.00(329.00,366.00) -1.030 0.303
RDW-CV(%) 15.80(14.70,19.40) 14.20(13.20,17.50) -0.818 0.413
RDW-SD(fL) 44.00(38.70,56.50) 44.20(41.50,48.30)b -0.931 0.352
PLT(×109/L) 296.00(201.00,390.00)a 259.00(225.00,280.00) -2.030 0.042
PDW-CV(%) 39.00(38.30,39.20) 38.30(36.60,39.10) -0.265 0.791
PDW-SD(fL) 16.80(15.80,19.00) 16.60(14.10,18.70) -0.934 0.350
MPV(fL) 5.80(4.80,7.90)a 7.10(6.30,7.90)b -0.327 0.744
PCT(%) 0.15(0.13,0.19)a 0.18(0.14,0.25) -2.076 0.038
P-LCR 23.24(17.54,27.93)a 27.10(22.19,32.40) -0.926 0.354
ESR(mm/h) 45.00(25.00,85.00)a 75.00(56.00,95.00)b -3.449 0.001
CRP(mg/L) 9.30(9.10,11.30)a 9.70(9.10,11.60)b -3.419 0.001
图1 肺结核患者入组诊断时胸部CT 平扫。 注:A:痰转阴组患者CT 图像(上叶多发结节,条索影;胸腔少量积液,局部胸膜增厚);B:痰未转阴组患者CT 图像(上叶多发结节,部分成磨玻璃样;肺大泡;纵隔多发小淋巴结)
表3 肺结核患者Spearman 秩相关性分析
表4 血液学参数联合模型对痰转阴的预测
1
吕恒梁,张 馨,张文义,等.肺结核流行病学特征及影响因素研究进展[J].疾病监测,2024,39(2):207-214.
2
任成山,林 辉,杨仕明.结核病的流行特征与耐多药的窘迫及其策略[J/CD].中华肺部疾病杂志(电子版),2019,12(3):269-274.
3
蔡小芳,高 慧,葛 军,等.多重耐药性肺结核治疗依从性预测分析[J/CD].中华肺部疾病杂志(电子版),2024,17(1):51-56.
4
Günther G,Heyckendorf J,Zellweger JP,et al.Defining outcomes of tuberculosis (treatment):from the past to the future [J].Respiration,2021,100(9):843-852.
5
Heyckendorf J,Georghiou SB,Frahm N,et al.Tuberculosis treatment monitoring and outcome measures:new interest and new strategies[J].Clin Microbiol Rev,2022,35(3):e0022721.
6
Zhang F,Zhang F,Dong Y,et al.New Insights into Biomarkers for Evaluating Therapy Efficacy in Pulmonary Tuberculosis:A Narrative Review[J].Infect Dis Therapy,2023,12(12):2665-2689.
7
Zimmer AJ,Lainati F,Aguilera Vasquez N,et al.Biomarkers that correlate with active pulmonary tuberculosis treatment response:a systematic review and meta-analysis[J].J Clin Microbiol,2022,60(2):e0185921.
8
Shah AR,Desai KN,Maru AM.Evaluation of hematological parameters in pulmonary tuberculosis patients[J].J Family Med Prim Care,2022,11(8):4424-4428.
9
Kumar A,Gurram L,Naga Ch P,et al.Correlation of hematological parameters with clinical outcomes in cervical cancer patients treated with radical radio(chemo)therapy:a retrospective study[J].Int J Radiat Oncol Biol Phys,2024,118(1):182-191.
10
Tu HZ,Lai TJ,Chen YS,et al.Hematological parameters as potential markers for distinguishing pulmonary tuberculosis from genitourinary tuberculosis[J].Pathogens,2023,12(1):84-93.
11
Batool Y,Pervaiz G,Arooj A,et al.Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis[J].Pak J Med Sci,2022,38(7):1968-1972.
12
Kerget B,Afʂin DE,Aksakal A.The role of systemic immuneinflammation index ( SII ) in the differential diagnosis of granulomatous and reactive LAP diagnosed by endobronchial ultrasonography[J].Sarcoidosis Vasc Diffuse Lung Dis,2023,40(3):e2023038.
13
刘小利,刘 涛.新版《肺结核诊断标准》解读[J].中华灾害救援医学,2018,6(4):181-183.
14
Asemahagn MA.Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone,Northwest Ethiopia:a longitudinal study[J].BMC Pulm Med,2021,21(1):118-127.
15
Nguyen MVH,Levy NS,Ahuja SD,et al.Factors associated with sputum culture-negative vs culture-positive diagnosis of pulmonary tuberculosis[J].JAMA Netw Open,2019,2 (2):e187617-e187617.
16
Schumacher SG,Wells WA,Nicol MP,et al.Guidance for studies evaluating the accuracy of sputum-based tests to diagnose tuberculosis[J].J Infect Dis,2019,220(Supplement_3):S99-S107.
17
Heyckendorf J,Georghiou SB,Frahm N,et al.Tuberculosis treatment monitoring and outcome measures:new interest and new strategies[J].Clin Microbiol Rev,2022,35(3):e00227-21.
18
Miyahara R,Piyaworawong S,Naranbhai V,et al.Predicting the risk of pulmonary tuberculosis based on the neutrophil-to-lymphocyte ratio at TB screening in HIV-infected individuals[J].BMC Infect Dis,2019,19(1):667-675.
19
Li K,Liu SX,Yang CY,et al.A routine blood test-associated predictive model and application for tuberculosis diagnosis:a retrospective cohort study from northwest China[J].J Int Med Res,2019,47(7):2993-3007.
20
Jeon YL,Lee WI,Kang SY,et al.Neutrophil-to-monocyte-pluslymphocyte ratio as a potential marker for discriminating pulmonary tuberculosis from nontuberculosis infectious lung diseases[J].Lab Med,2019,50(3):286-291.
21
Javed I,Javed MT,Mahmood Z,et al.Hematological profiling of tuberculosis-infected and co-morbid patients:a study carried out in central Punjab,Pakistan [ J].Eur J Inflamm,2018,16:2058739218818684.
22
Stefanescu S,Cocoş R,Turcu-Stiolica A,et al.Prediction of treatment outcome with inflammatory biomarkers after 2 months of therapy in pulmonary tuberculosis patients:preliminary results[J].Pathogens,2021,10(7):789-805.
23
Cercamondi CI,Stoffel NU,Moretti D,et al.Iron homeostasis during anemia of inflammation:a prospective study of patients with tuberculosis[J].Blood,2021,138(15):1293-1303.
24
Come YFR,Buntoro IF,Setiono KW,et al.The effect of intensive phase of anti tuberculosis drugs with hemoglobin levels in tuberculosis patients in kupang city[J].CMJ,2023,11(1):24-32.
25
Portier I,Campbell RA.Role of platelets in detection and regulation of infection[J].Arteriosclerosis,thrombosis,and vascular biology,2021,41(1):70-78.
26
Tozkoparan E,DenizO,Ucar E,et al.Changes in platelet count andindices in pulmonary tuberculosis[J].Clin Chem Lab Med,2007,45(8):1009-1013.
27
Bozdemir ŞE,Aslaner H.Can neutrophil to lymphocyte ratio and monocyte to lymphocyte ratio be used in the diagnosis of childhood tuberculosis? [J].Online Türk Saglık Bilimleri Dergisi,2021,6(4):521-527.
28
Biyik M,Biyik Z,Asil M,et al.Systemic inflammation response index and systemic immune inflammation index are associated with clinical outcomes in patients with acute pancreatitis? [ J].J Investigat Surg,2022,35(8):1613-1620.
29
李艳芳,陈 骥,范 凌.肺结核患者治疗前后血清甘露糖结合凝集素、巨噬细胞炎症蛋白-1α 及C 反应蛋白水平变化及其临床意义[J].标记免疫分析与临床,2020,27(1):105-109.
[1] 李可心, 鲁瑞, 田燕, 王文俊, 李维, 万月强, 翟嵩, 刘拉羊. 阿达木单抗治疗银屑病致播散性肺结核一例并文献复习[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 245-249.
[2] 王迎迎, 谢平. 乙型肝炎病毒感染合并肺结核患者发生肝损伤的危险因素及预测模型构建[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 267-273.
[3] 王超, 包训迪, 徐东芳, 王庆. 实时荧光核酸恒温扩增技术、GeneXpert和BACTEC MGIT960液体快速培养法对涂阴肺结核的诊断效能[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(01): 41-47.
[4] 张燕, 杨跃青, 邱峥. IgG 联合血清细胞因子对肺结核并发慢性肺曲霉菌病的诊断意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 809-812.
[5] 白若靖, 郭军. 维生素D对肺部疾病临床意义的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 659-662.
[6] 徐辉, 杨勇琼, 刘健, 许剑, 江佳莲, 邓正波. s-ChE、PCT、CRP在肺结核中的表达及继发肺部感染的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 292-295.
[7] 沙敏, 瞿秋霞, 朱卫东, 陈成. 肺结核与肺结节病相关肉芽肿组织中CXCR5的差异性表达[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 189-194.
[8] 蔡小芳, 高慧, 葛军, 邢慧芸, 庄小燕, 李小丁. 多重耐药性肺结核治疗依从性预测分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 51-56.
[9] 孟原竹, 蒋国路, 陈小兵, 蒋莉. 肺结核合并侵袭性肺曲霉感染临床特征及危险因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(04): 541-543.
[10] 肖泽林, 高健齐, 刘家杰, 曾定科. 负压封闭引流术治疗胸壁结核的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(03): 397-399.
[11] 张燕珍, 王锡携, 文小兰. 血清巨噬细胞迁移抑制因子对活动性肺结核分诊检测的意义[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(02): 200-202.
[12] 万秋, 杨伏萍, 唐莉歆. 含氯法齐明的联合方案治疗耐多药肺结核的疗效及安全性分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(02): 275-277.
[13] 赵延军, 张红军, 贾丽娟, 顾兴, 李文洁, 柴雅琴, 冯斐, 张海涛. 疑难肺部阴影临床与病理分析[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(01): 26-30.
[14] 郭文秀, 吴胜男, 王小芸, 张敏. 基于网络药理学的百部联合川贝母治疗肺结核的作用机制研究[J/OL]. 中华临床医师杂志(电子版), 2023, 17(03): 335-342.
[15] 徐韫健, 吴柳, 尹小毛. 结核病γ-干扰素释放试验假阴性的影响因素分析[J/OL]. 中华临床实验室管理电子杂志, 2024, 12(02): 75-79.
阅读次数
全文


摘要