The Clinical Value Of NLR And MPV In The Differential Diagnosis Between Pulmonary Tuberculosis And Bacterial Community-Acquired Pneumonia

SUBJECT:At the early stage of TB and CAP, clinical symptoms have fever, cough, expectoration and acratia hypodynamia. Imaging results are also similar, such as patch inflammatory effusions or consolidation change. Due to TB’s non-specificity in imaging and clinical symptoms, andthe detection rate of acid fast bacilli from patient’s sputum below 50%-60%, the differential diagnosis has become the important problem and urgently needed to be solved for clinical doctors,especiallyrespiration doctors. Delayed diagnosis has bad effects on the incidence and mortality rate of TB patients. If the open tuberculosis patients didn’t get a definite diagnosis and effective isolation therapy, it could lead to the infection of other hospitalized patients and medical staff. In lately years, research indicates that sTREM-1,CRP and PCT have a certain role in differential diagnosis of bacterial CAP and TB. However, there haven’t exist some indicator or technique meeting the clinical need as so far.METHOD:This study retrospectively selects patients with bacterial CAP and TB during January 2012 and October 2015 in the Eastern Hospital of Provincial Hospital Affiliated to Shandong University, and all cases are above 18 years old. In this study, all the data are collected retrospectively. Blood samples collected from each patient are fasting blood collected prior to the use of antibiotics. Meanwhile we record the number of age,gender, whole blood cell count and differential counting, MPV and CRP and so on. Then we analyze each patient’s blood sample. And we calculate the NLR number through the total number of neutrophile granulocytes and the total number of lymphocytes.RESULT:Patients with bacterial CAP enrolled in are 13 cases, among them,7 cases are male and 6 are female, aged 19-61 years old, the middle number is 36.Patients with TB enrolled in are 20 cases, among them,8 cases are male and 12 are female, aged 21-70 years old, the middle number is 44.4.According to chi-square test, there is no significant difference in gender and age between the two groups(P is 0.643 and 0.191 respectively)However, the history of the two groups of patients has significant difference except for cough.The number of WBC in CAP group is (12.46±1.55)×109/L, apparently higher than the number (11.00±1.50)×109/L in TB group.The difference is statistically significant(t=2.626,P=0.013);The number of neutrophils in CAP group is (8.19±1.13)×109/L, apparently higher than the number (6.70±1.58)×109/L in TB group.The difference is statistically significant(t=2.852,P=0.008);The number of lymphocytes in CAP group is (3.61±0.50)×109/L, apparently higher than the number (5.24±0.64)×109/L in TB group.The difference is statistically significant(t=-2.89,P=0.007);The ESR in CAP group is (29.58±17.35)mm/h, apparently lower than the ESR (43.50±17.88)mm/h in TB group. The difference is statistically significant(t=-2.155,p=0.039);The number of NLR in CAP group is (7.69±2.28),apparently higher than (5.04±1.33) in TB group.The difference is statistically significant(t=4.175,p=0.000);The number of MPV in CAP group is (10.13±1.18)fl, little higher than (9.90±0.76)fl in TB group. The difference is statistically significant(t=0.682,p=0.501).Taking NLR<5.72 as the critical value to diagnose TB and CAP, the sensibility is 75%,specificity is 91.7%;Taking WBC<10.8×109/L as the critical value to diagnose TB and CAP, the sensibility is 55%,specificity is 91.7%;Taking neutrophils<6.99×109/L as the critical value to diagnose TB and CAP, the sensibility is 65%,specificity is 91.7%;Taking lymphocytes>3.71×109/L as the critical value to diagnose TB and CAP, the sensibility is 80%,specificity is 91.7%;Taking ESR>26mm/h as the critical value to diagnose TB and CAP, the sensibility is 90%,specificity is 75%.Area under the curve of NLR is 0.867,[CI] is 0.700-0.960,apparently higherthanWBC(0.744,[CI]0.559-0.881),neutrocytes(0.794,[CI]0.614-0.916),lympho cytes(0.746, [CI]0.561-0.882), ESR(0.746, [CI]0.561-0.862).CONCLUSION:1.As a new inflammatory indicator in blood, NLR is easy to detect and affordable.It can be an effective indicator in differential diagnosis of TB and bacterial CAP, so it has certain application value. It can be extended to the primary health institutions.2.This study illustrates that MPV has no clinical significance to the differential diagnosis of TB and bacterial CAP.3.The value of NLR to the differential diagnosis lies in the number of total white blood cells,lymphocytes, neutrophils and ESR.4.Simultaneous determination of the number of total white blood cells, lymphocytes, neutrophils and ESR helps the differential diagnosis.