摘要
目的 研究白细胞计数(WBC)、单核细胞与淋巴细胞比值(MLR)、腺苷脱氨酶(ADA)及纤维蛋白原降解产物(FDP)联合应用在社区获得性肺炎(CAP)与肺结核鉴别诊断中的价值.方法 回顾性收集2020年1月至2023年12月贵州医科大学附属医院感染科收治住院的203例成人CAP和191例肺结核患者,分别作为CAP组和肺结核组.比较两组患者基本资料及WBC、MLR、ADA、FDP的差异,使用单因素Logistic回归分析WBC、MLR、ADA、FDP与肺结核相关性,绘制受试者操作特征(ROC)曲线分析WBC、MLR、ADA、FDP单独及联合应用在鉴别CAP和肺结核中的价值.结果 CAP组患者体重指数大于肺结核组患者,差异有统计学意义(P＜0.05).CAP组的WBC为7.76(5.70,10.67)×109/L,高于肺结核组[6.47(5.14,8.10)× 109/L],MLR、ADA、FDP 水平 分别为 0.34(0.24,0.58)、9.1(7.1,12.4)U/L、1.63(0.70,4.10)μg/mL,均低于肺结核组[0.50(0.33,0.80)、13.0(10.4,16.5)U/L、3.80(1.18,8.00)μg/mL],差异均有统计学意义(P＜0.05).单因素Logistic回归分析结果显示WBC、MLR、ADA、FDP均与肺结核有相关性(P＜0.05).WBC、MLR、ADA、FDP 在 CAP 与肺结核的鉴别中曲线下面积(AUC)分别为 0.635(95％CI:0.581～0.689)、0.651(95％CI:0.597～0.705)、0.745(95％CI:0.697～0.793)、0.632(95％CI:0.578～0.687),四者联合应用时 ROC曲线结果显示AUC为0.77(95％CI:0.724～0.816),敏感度及特异度分别为73.8％和70.9％.结论 CAP患者与肺结核患者的WBC、MLR、ADA及FDP有明显差异,四者联合应用可更有效对CAP与肺结核进行鉴别,为CAP与肺结核的早期鉴别提供了一定的诊疗思路.
Abstract
Objective To investigate the value of the combination of white blood cell count(WBC),monocyte to lymphocyte ratio(MLR),adenosine deaminase(ADA)and fibrinogen degradation product(FDP)in the differential diagnosis of community-acquired pneumonia(CAP)and pulmonary tuberculosis.Methods A total of 203 adult patients with CAP and 191 patients with pulmonary tuberculosis admitted to the Department of Infection of the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2023 were retrospectively col-lected as CAP group and pulmonary tuberculosis group,respectively.Differences in general data,WBC,MLR,ADA and FDP were compared be-tween the two groups.The correlation between WBC,MLR,ADA,FDP and pulmonary tuberculosis was analyzed using univariate Logistic regres-sion analysis,and receiver operating characteristic(ROC)curve was drawn to analyze the value of WBC,MLR,ADA and FDP alone and in com-bination in the identification of CAP and pulmonary tuberculosis.Results The body mass index of patients in the CAP group was higher than that of patients in the pulmonary tuberculosis group,and the difference was statistically significant(P＜0.05).The WBC of the CAP group was 7.76(5.70,10.67)× 109/L,which was higher than that of the pulmonary tuberculosis group[6.47(5.14,8.10)× 109/L],the levels of MLR,ADA,and FDP in the CAP group were 0.34(0.24,0.58),9.1(7.1,12.4)U/L,and 1.63(0.70,4.10)μg/mL,respectively,which were lower than those in the pulmonary tuberculosis group[0.50(0.33,0.80),13.0(10.4,16.5)U/L,3.80(1.18,8.00)]μg/mL,the differ-ences were statistically significant(P＜0.05).The results of single factor Logistic regression analysis showed that WBC,MLR,ADA,FDP were all correlated with pulmonary tuberculosis(P＜0.05).The area under the curve(AUC)of WBC,MLR,ADA and FDP in the differential diag-nosis of CAP and pulmonary tuberculosis were 0.635(95％CI:0.581-0.689),0.651(95％CI:0.597-0.705),0.745(95％CI:0.697-0.793)and 0.632(95％CI:0.578-0.687),respectively.When the four were used together,the ROC curve showed that AUC,sensitivity and specificity were 0.77(95％CI:0.724-0.816),73.8％and 70.9％,respectively.Conclusion There are significant differences in WBC,MLR,ADA,and FDP between CAP patients and pulmonary tuberculosis patients.The combination of the four can more effectively distinguish between CAP and pulmonary tuberculosis,providing a certain diagnostic and therapeutic approach for the early differentiation of CAP and pulmonary tuberculosis.
基金项目
贵州省人才基地"贵州省感染病防控人才基地"支持项目(第八批)(黔人领发[2020]8号)
维普
万方数据