Monocyte at diagnosis as a prognosis biomarker in tuberculosis patients with anemia.
Monocyte at diagnosis as a prognosis biomarker in tuberculosis patients with anemia.
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DOI：
10.3389/fmed.2023.1141949
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发表时间：
2023
影响因子：
3.9
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中科院分区：
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在结核病患者中，贫血导致治愈率低、预后差。迫切需要有效的预测结核病合并贫血(A-TB)预后的指标。单核细胞已被证明是许多肺部疾病的预后生物标志物。单核细胞作为主要的先天免疫细胞作为结核病的早期防御细胞是否能够预测A-TB，目前尚不清楚。对上海市肺科医院收治的初治甲型肺结核患者资料进行回顾性收集和分析。采用Logistic回归分析研究外周血细胞与治疗结果的相关性。用受试者工作特性(ROC)曲线确定临界值。我们使用Kaplan-Meier技术估计了12个月的预后。采用COX比例风险模型进行单因素和多因素分析，分析影响A-TB预后不良的因素。在分析的181例患者中，94例治愈，87例未治愈。Logistic回归分析显示单核细胞是影响A-TB预后的独立免疫相关危险因素(OR：7.881，95%CI：1.675~37.075，P=0.009)。单核细胞数0.535×109/L K-M分析显示，单核细胞数0.535×109/L组的累积治愈率(69.62%)显著高于单核细胞数为0.535×109/L组(38.24%)(Log-ranch，χ2=16.530，P<；0.0001)。在单变量和多变量分析中，单核细胞是A-TB预后不良的独立预测因子。同样，单核细胞也是A-TB肺腔闭合不良的独立预测因素(HR：3.614，95%CI：1.335-9.787，P=0.011)。在A-TB患者中，单核细胞升高与预后不良和空洞肺闭合不良有关。单核细胞可能为A-TB提供一种简单、廉价的预后生物标志物。
Anemia leads to a lower cure rate and poor prognosis in tuberculosis patients. Effective predictors for the prognosis of tuberculosis with anemia (A-TB) are urgently needed. Monocyte has been proven to be a prognostic biomarker of many lung diseases. Whether monocyte that the predominant innate immune cell as early defense against tuberculosis can predict A-TB is not known. Data for A-TB patients with initial treatment in Shanghai Pulmonary Hospital were retrospectively collected and analyzed. Logistics regression analysis was used to study the correlation between peripheral blood cells and treatment outcomes. The receiver operating characteristic (ROC) curve was used to determine the cut-off value. We estimated a 12-month prognosis using Kaplan–Meier techniques. The Cox proportional hazards model was used for the univariate and multivariate analyses to analyze the predictors of poor prognosis of A-TB. Of 181 patients analyzed, 94 were cured and 87 non-cured. Logistic regression analysis identified monocyte as an independent immune-related risk factor for the prognosis of A-TB (OR: 7.881, 95% CI: 1.675–37.075, P = 0.009). The ROC curve analysis proved that the most discriminative cut-off value of monocyte was 0.535 × 10^9/L. K–M analysis demonstrated that the cumulative cure rates of A-TB were significantly higher in A-TB with monocyte < 0.535 × 10^9/L (69.62%) than that in those with monocyte ≥ 0.535 × 10^9/L (38.24%) (Log-rank, χ2 = 16.530, P < 0.0001). On univariate and multivariable analysis, monocyte was an independent predictor of poor prognosis in A-TB. Similarly, monocyte was also an independent predictor of poor pulmonary cavity closure in A-TB (HR: 3.614, 95% CI: 1.335–9.787, P = 0.011). In A-TB patients, elevated monocyte was associated with poor prognosis and poor cavity pulmonary closure. Monocyte may provide a simple and inexpensive prognostic biomarker in A-TB.
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