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[1]陈 兰,沈 艳,金 柯,等.肺结核强化期治疗血液学特征的临床意义[J].中华肺部疾病杂志,2024,(06):913-919.[doi:10.3877/cma.j.issn.1674-6902.2024.06.011
]
　Chen Lan,Shen Yan,Jin Ke,et al.Clinical significance of hematological features after intensive treatment of pulmonary tuberculosis[J].,2024,(06):913-919.[doi:10.3877/cma.j.issn.1674-6902.2024.06.011
]
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肺结核强化期治疗血液学特征的临床意义(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2024年06期
页码:
913-919
栏目:
论著
出版日期:
2024-12-25

文章信息/Info

Title:
Clinical significance of hematological features after intensive treatment of pulmonary tuberculosis
作者:
陈 兰; 沈 艳; 金 柯; 史 萍; 邓露茜; 石丽萍
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
Author(s):
Chen Lan;  Shen Yan;  Jin Ke;  Shi Ping;  Deng Luqian;  Shi Liping.
Department of Infectious Diseases ICU, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Provincial People's Hospital, Nanjing 210000, China
关键词:
肺结核;  强化期;  血液学参数;  痰转阴
Keywords:
Pulmonary tuberculosis;  Strengthening period;  Hematological parameters;  Sputum negative conversion
分类号:
R562
DOI:
10.3877/cma.j.issn.1674-6902.2024.06.011
摘要:
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。
Abstract:
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.

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备注/Memo

备注/Memo:
基金项目: 江苏省自然科学基金青年项目(SBK2020040678)
通信作者: 沈 艳, Email: shengyan198903@163.com
更新日期/Last Update: 2024-12-25