Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy.
Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy.
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DOI：
10.1093/infdis/jit494
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发表时间：
2014-02-15
期刊：
影响因子：
--
通讯作者：
Fletcher H
中科院分区：
文献类型：
--
作者：
Naranbhai V;Hill AV;Abdool Karim SS;Naidoo K;Abdool Karim Q;Warimwe GM;McShane H;Fletcher H
背景。80年前，人们注意到单核细胞与淋巴细胞的比率（以下简称“ML比率”）会影响兔分枝杆菌感染的结果。最近的转录组学研究支持骨髓和淋巴转录物的相对比例在结核病预后中的作用。众所周知，外周血中的ML比例是由造血干细胞控制的，具有明显的偏倚。方法。基线ML比率的预测价值在南非开始cART的hiv感染成人的2个前瞻性队列中进行建模（主要队列，1862名参与者；重复队列，345名参与者）。根据当代指南，通过临床、放射学和微生物学方法诊断偶发结核。进行Kaplan-Meier生存分析和Cox比例风险建模。结果。基线ML比率差异显著：ML比率低于第5百分位、介于第5至第95百分位和大于第95百分位时，每1000患者年结核病发病率分别为32.61（95%可信区间[CI]， 15.38-61.54）、16.36 （95% CI, 12.39-21.23）和51.80 (95% CI, 23.10-101.71) （P = 0.007）。单核细胞计数和淋巴细胞计数均与结核无关。在调整性别、世界卫生组织人类免疫缺陷病毒疾病分期、CD4+ t细胞计数和既往结核病史后，ML比小于第5百分位或大于第95百分位的患者的疾病风险显著更高（校正风险比为2.47；95% CI为1.39-4.40;P = 0.002）。结论。ML比值可能是一种有用的、容易获得的工具，用于对结核病的风险进行分层，并提示在结核病发病机制中涉及造血干细胞偏倚。
Background. Eight decades ago, the ratio of monocytes to lymphocytes (hereafter, the “ML ratio”) was noted to affect outcomes of mycobacterial infection in rabbits. Recent transcriptomic studies support a role for relative proportions of myeloid and lymphoid transcripts in tuberculosis outcomes. The ML ratio in peripheral blood is known to be governed by hematopoietic stem cells with distinct biases. Methods. The predictive value of the baseline ML ratio was modeled in 2 prospective cohorts of HIV-infected adults starting cART in South Africa (primary cohort, 1862 participants; replication cohort, 345 participants). Incident tuberculosis was diagnosed with clinical, radiographic, and microbiologic methods per contemporary guidelines. Kaplan-Meier survival analyses and Cox proportional hazards modeling were conducted. Results. The incidence rate of tuberculosis differed significantly by baseline ML ratio: 32.61 (95% confidence interval [CI], 15.38–61.54), 16.36 (95% CI, 12.39–21.23), and 51.80 (95% CI, 23.10–101.71) per 1000 patient-years for ML ratios of less than the 5th percentile, between the 5th and 95th percentiles, and greater than the 95th percentile, respectively (P = .007). Neither monocyte counts nor lymphocyte counts alone were associated with tuberculosis. After adjustment for sex, World Health Organization human immunodeficiency virus disease stage, CD4+ T-cell counts, and previous history of tuberculosis, hazards of disease were significantly higher for patients with ML ratios of less than the 5th percentile or greater than the 95th percentile (adjusted hazard ratio, 2.47; 95% CI, 1.39–4.40; P = .002). Conclusions. The ML ratio may be a useful, readily available tool to stratify the risk of tuberculosis and suggests involvement of hematopoietic stem cell bias in tuberculosis pathogenesis.
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影响因子：
4.4
作者：
Gideon, Hannah P.;Flynn, JoAnne L.
通讯作者：
Flynn, JoAnne L.
影响因子：
56.3
作者：
Rangaka, Molebogeng X.;Wilkinson, Katalin A.;Glynn, Judith R.;Ling, Daphne;Menzies, Dick;Mwansa-Kambafwile, Judith;Fielding, Katherine;Wilkinson, Robert J.;Pai, Madhukar
通讯作者：
Pai, Madhukar
影响因子：
64.8
作者：
通讯作者：
--
DOI：
10.1056/nejmoa1011214
发表时间：
2011-07-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Madhi SA;Nachman S;Violari A;Kim S;Cotton MF;Bobat R;Jean-Philippe P;McSherry G;Mitchell C;P1041 Study Team
通讯作者：
P1041 Study Team
DOI：
10.1056/nejmoa0905848
发表时间：
2010-02-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Abdool Karim SS;Naidoo K;Grobler A;Padayatchi N;Baxter C;Gray A;Gengiah T;Nair G;Bamber S;Singh A;Khan M;Pienaar J;El-Sadr W;Friedland G;Abdool Karim Q
通讯作者：
Abdool Karim Q