The Clinical Value Of Neutrophil-lymphocyte Ratio In The Differential Diagnosis Of Pulmonary Tuberculosis And Bacterial Community-acquired Pneumonia

In the early stage of pulmonary tuberculosis and bacterial communityacquired pneumonia,the clinical manifestations and imaging changes are similar and non-specific.The positive rate of acid-fast bacilli detected by sputum smear and sputum culture is low,and delayed diagnosis will bring adverse effects on patients infected with mycobacterium tuberculosis,and failure to conduct early diagnosis and effective isolation of patients with active tuberculosis will lead to the spread of tuberculosis.So early identification of pulmonary tuberculosis patients is crucial.Objective:The clinical value of neutrophil-lymphocyte ratio in the differential diagnosis of pulmonary tuberculosis and bacterial community-acquired pneumonia was compared.Method:From Dec.2016 to Jul.2019,111 cases of pulmonary tuberculosis patients and 120 cases of bacterial community-acquired pneumonia patients diagnosed in the department of respiratory medicine of The First Hospital of Jilin University were retrospectively collected,and the differences in gender,age,basic diseases,clinical symptoms and laboratory indicators between the two groups were compared and analyzed.Result:1.Comparison of general data: there was no statistically significant difference in age,gender,history of tuberculosis between the two groups of patients.(P>0.05).2.Comparison of basic diseases: the number of patients with hypertension,diabetes,coronary heart disease,hepatitis and cerebrovascular disease in the PTB group was not significantly different from that in the bacterial CAP group(P>0.05).3.Comparison of clinical symptoms: there was no significant difference in the three clinical symptoms of cough,night sweat and hemoptysis between the two groups(P>0.05),but patients in the bacterial CAP group were more likely to have fever,and the difference was statistically significant(P<0.05).At the same time,compared with the bacterial CAP group,PTB group was more prone to weight loss and had a longer course of disease,and the difference was statistically significant(P<0.05).4.Comparison of serological indicators: the total number of white blood cells,neutrophil count,NLR and CRP level of patients in the bacterial CAP group were significantly higher than those in the PTB group,with statistically significant differences(P<0.05).However,the lymphocyte count and ESR level of the bacterial CAP group were significantly lower than that of the PTB group,with statistically significant differences(P<0.05).Meanwhile,there was no significant difference in PCT level between the two groups(P>0.05).5.ROC curve analysis showed that when NLR was 4.75,the sensitivity,specificity and AUC value of the differential diagnosis between PTB and bacterial CAP were 71.9%,65.0% and 0.702,respectively.The value of the differential diagnosis was better than the total number of white blood cells,neutrophil count,lymphocyte count,CRP and ESR.6.Correlation analysis showed that the correlation between NLR and neutrophil count was the strongest(r=0.711,P<0.001).NLR was positively correlated with WBC(r=0.525,P<0.001),CRP(r=0.569,P<0.001),and ESR(r=0.213,P=0.001).NLR was negatively correlated with lymphocyte count(r=-0.668,P<0.001).Conclusion:1.NLR may be an effective indicator for the differential diagnosis of patients with pulmonary tuberculosis and bacterial community-acquired pneumonia.Its detection is convenient and inexpensive,and it can be promoted to primary hospitals.2.The value of NLR in the differential diagnosis of pulmonary tuberculosis and bacterial community-acquired pneumonia was superior to the inflammatory indicators(blood leukocyte count,neutrophil count,lymphocyte count,CRP and ESR).If at the same time the combination of the inflammatory indicators is more conducive to the differential diagnosis of the two diseases.3.NLR was positively correlated with the total number of white blood cells,neutrophil count,CRP and ESR,and the correlation with neutrophil count was the strongest.It was negatively correlated with lymphocyte count.