| Purpose:In this study,we tride to explore the value of combined detection of peripheral blood monocyte / lymphocyte ratio(MLR),neutrophil / lymphocyte ratio(NLR)and Tcell dot test(T-SPOT.TB)in the diagnosis of bacteria-negative pulmonary tuberculosis,and to provide a new idea for the diagnosis of bacteria-negative pulmonary tuberculosis.Methods:70 patients with sputum-negative pulmonary tuberculosis treated in Jiangxi Thoracic Hospital from October 2021 to September 2022 were retrospectively analyzed as the study group,and another 50 patients with non-tuberculosis infection were selected as the control group.The general baseline data of the two groups were collected,including sex,age,body mass index(BMI)and underlying diseases.All patients were admitted to the hospital for blood cell analysis and peripheral blood TSPOT.TB detection.The results of the first blood cell analysis after admission were collected,and the corresponding levels of MLR and NLR were calculated according to the relevant definitions.The general baseline data were compared with SPSS software to determine the comparability of the two groups of subjects,and then to compare the differences of monocytes(Mono),neutrophils(Neu),lymphocytes(Lym)and MLR and NLR values between sputum-negative pulmonary tuberculosis patients and nontuberculosis pulmonary disease patients.The difference of positive rate of T-SPOT.TB between the two groups was compared.MLR and NLR used the receiver working characteristic curve(ROC)analysis to determine the best diagnostic value of MLR and NLR,and further analyzed the single test of MLR,NLR and T-SPOT.TB and the detection efficiency of the abovementioned indexes in the diagnosis of sputum-negative pulmonary tuberculosis.The sensitivity and specificity of diagnosis were determined according to the area under the curve,and the Yoden index was calculated.Results:1.The clinical data of 120 patients were included in this study,including 70 patients with bacterial negative pulmonary nodules and 50 patients with nontuberculosis pulmonary diseases.Two groups of ordinary baseline data differences such as gender,age,BMI,no statistical significance(P > 0.05),comparable.2.Two groups of peripheral blood parameters of Mono,Lym,MLR,NLR expression level in germ feminine tuberculosis patients group is significantly higher than the tuberculosis infection.3.The positive rate of sputum-negative pulmonary tuberculosis diagnosed by single method was compared.The T-SPOT.TB results of the two groups showed that of the 70 patients with sputum-negative pulmonary tuberculosis,63(90.0%)were positive and 7(10.0%)were negative.Of the 50 patients with other lung diseases,31 were positive(62.0%)and 19 were negative(38.0%).The positive rate of T-SPOT.TB,the chi square test,the difference was statistically significant(P < 0.05),bacterium Yin tuberculosis group is higher than a sense of TB.The MLR value of the two groups was 0.341 by ROC analysis,and the result was greater than this value as positive,showing 70 cases of bacteria-negative pulmonary tuberculosis,including 53 positive cases(75.7%)and 17 negative cases(24.3%).Of the 50 patients with other lung diseases,18 were positive(36.0%)and 32 were negative(64.0%).The positive rate of MLR was significantly different between the two groups by χ 2 test.The diagnostic value of NLR between the two groups was 1.899 by ROC analysis,and the result was greater than this value as positive,showing 70 cases of negative pulmonary tuberculosis,including 57 positive cases(81.4%)and 13 negative cases(18.6%).Among the 50 patients with other pulmonary diseases,20(40.0%)were positive and 30(60.0%)were negative.By χ 2 test,there was significant difference in the positive rate of NLR.And germ feminine pulmonary tuberculosis group of MLR,NLR alone diagnosis positive rate is significantly higher than the group of patients with tuberculosis of lung disease.4.T-SPOT.TB combined with other two methods in the diagnosis of sputumnegative pulmonary tuberculosis,the results of T-SPOT.TB+MLR diagnosis of sputum-negative pulmonary tuberculosis in the two groups showed that there were 70 cases of sputum-negative pulmonary tuberculosis,of which 68(97.1%)were positive and 2(2.9%)were negative.There were 50 patients with other lung diseases,including37 positive cases(74.0%)and 13 negative cases(26.0%).The positive rate of TSPOT.TB+MLR was compared by χ 2 test,the difference was statistically significant(P < 0.05.The results of T-SPOT.TB+NLR diagnosis of sputum-negative pulmonary tuberculosis in the two groups showed that there were 70 cases of sputum-negative pulmonary tuberculosis,of which 69 cases were positive(98.6%)and 1 case was negative(1.4%).Of the 50 patients with other pulmonary diseases,40 were positive(80.0%)and 10 were negative(20.0%).The positive rate of T-SPOT.TB+NLR was significantly different by χ 2 test.Parallel test and series test could be used in the combined diagnosis of the three.If any of the three indexes were positive in the parallel test,it would be regarded as positive for T-SPOT.TB+ MLR+NLR,and if all the three indexes were positive in the series test,it would be regarded as positive for TSPOT.TB*MLR*NLR.The T-SPOT.TB+MLR+NLR results of the two groups showed70 cases of negative pulmonary tuberculosis,of which 69 cases were positive(98.6%)and 1 case was negative(1.4%).Of the 50 patients with other pulmonary diseases,40 were positive(80.0%)and 10 were negative(20.0%).The positive rate of TSPOT.TB+MLR+NLR was compared by χ 2 test,and the difference was statistically significant.The results of T-SPOT.TB*MLR*NLR between the two groups showed 70 cases of bacterial negative pulmonary tuberculosis,of which 40 cases were positive(57.1%)and 30 cases were negative(42.9%).There were 50 patients with other lung diseases,including 8 positive cases(16.0%)and 42 negative cases(84.0%).By χ 2 test,there was significant difference in the positive rate of T-SPOT.TB*MLR*NLR.5.The detection efficiency of different methods in the diagnosis of bacterianegative pulmonary tuberculosis,the results showed that the areas under the ROC curve of MLR,NLR and T-SPOT.TB were 0.753,0.739 and 0.640 respectively,and the diagnostic efficiency was the best when MLR was used as a single test index.when MLR took the best diagnostic value of 0.341,the sensitivity was 75.7%,the specificity was 64.0%,and the accuracy was 70.8%.When the best diagnostic value of NLR is1.899,the sensitivity is 84.3%,the specificity is 60.0%,and the accuracy is 72.5%.The sensitivity,specificity and accuracy of T-SPOT.TB diagnosis alone were 90.0%,38.0%and 68.3%,respectively.The areas under the ROC curve of T-SPOT.TB+MLR,TSPOT.TB+NLR,T-SPOT.TB+MLR+NLR 、 T-SPOT.TB* MLR* NLR were 0.616,0.593,0.593 and 0.706 respectively.When SPOT.TB*MLR*NLR was used as a combined detection index,the diagnostic efficiency was the best,with a sensitivity of57.1%,specificity of 84.0% and accuracy of 68.3%.The sensitivity,specificity,accuracy and accuracy of T-SPOT.TB+MLR detection are 97.1%,26.0%,67.5.3%,98.6%,20.0%,and 65.8%,respectively.Conclusion:1.The MLR and NLR of patients with bacterionegative pulmonary tuberculosis were higher than those in the non-tuberculosis-infected lung disease group,which could be used as a potential indicator to improve the diagnostic positivity rate of bacterionegative pulmonary tuberculosis.2.T-SPOT.TB combined with MLR and NLR detection has higher sensitivity and specificity than single index,which can improve the diagnostic efficiency of bacteriogenic tuberculosis. |
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