Effectiveness of the neutrophil number and mycobacterium tuberculosis load in sputum in predicting intensive treatment response in pulmonary tuberculosis patients
Objective To investigate the relationship between the sputum polymorphonuclear neutrophils(PMNs)count,the load of mycobacterium tuberculosis and the response to anti-tuberculosis intensive therapy in patients with sputum smear-positive pulmonary tuberculosis(PTB).Methods This is a retrospective case-control study completed in Shaanxi Provincial Tuberculosis Prevention Hospital from January to December 2021.Included were cases(sputum non-conversion group)who were≥18 years old with newly diagnosed PTB(sputum smear positive,rifampicin-sensitive),treated with the World Health Organization standard proto-col(fixed dose)for 2 months(intensive phase),and did not convert their sputum smear to negative.The inclu-sion criteria for the control group(sputum conversion group)were similar to those in the case group,except that sputum conversion was observed at the end of intensive treatment.Pretreatment levels of sputum PMNs,mycobacterium tuberculosis and other factors in patients with new-onset PTB were retrospectively analyzed.Results Compared with the case group,the number of PMNs and microscopic sputum mycobacterium tuber-culosis,AFB microscopic grading,load measured by sputum GeneXpert(Xpert-Probe B-Ct)in the control group were significantly lower,and Probe B cycle threshold and load measured by sputum GeneXpert(Xpert-Probe B-Ct)in the control group was higher(P<0.05).Xpert-Probe B-Ct value was significantly correlated with the mycobacterium tuberculosis in the corresponding sputum sample measured by AFB microscopy(r =-0.77,P<0.001).In the analysis of the receiver operating characteristic(ROC)curve,sputum PMNs had the highest predictive effect on sputum conversion delay,followed by GeneXpert-Probe B-Ct value and the load of sputum mycobacterium tuberculosis under microscopic examination,with areas under the curve(AUC)of 0.852,0.784 and 0.669,respectively.According to the multivariate regression model correction,number of sputum PMNs,and sputum mycobacterium tuberculosis measured by GeneXpert might be the main factors affecting the response of clinical anti-tuberculosis treatment(P<0.05).Conclusion The numbers of sputum PMNs before treatment and the sputum mycobacterium tuberculosis measured by GeneXpert have the potential of being markers for predicting post-intensive treatment response in PTB patients.
polymorphonuclear neutrophilsmycobacterium tuberculosis loadpulmonary tuberculosisre-sponse to intensive treatment
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