Monocyte-to-Lymphocyte Ratio Is Associated With Tuberculosis Disease and Declines With Anti-TB Treatment in HIV-Infected Children.
Monocyte-to-Lymphocyte Ratio Is Associated With Tuberculosis Disease and Declines With Anti-TB Treatment in HIV-Infected Children.
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DOI：
10.1097/qai.0000000000001893
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发表时间：
2019-02-01
期刊：
影响因子：
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通讯作者：
Cranmer LM
中科院分区：
文献类型：
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作者：
Choudhary RK;Wall KM;Njuguna I;Pavlinac PB;LaCourse SM;Otieno V;Gatimu J;Stern J;Maleche-Obimbo E;Wamalwa D;John-Stewart G;Cranmer LM
血液单核细胞与淋巴细胞比率（MLR）与成人活动性结核病（TB）相关，但尚未评估其在呼吸道取样困难的hiv感染儿童中作为结核病诊断生物标志物的价值。在一组开始抗逆转录病毒治疗的肯尼亚hiv感染住院儿童中，在入组时以及入组后4周、12周和24周测定绝对单核细胞和淋巴细胞计数。将儿童分为确诊、未确诊或不太可能患有肺结核。生成MLR截断值的ROC曲线，以区分确诊结核病儿童与未确诊和不太可能患有结核病的儿童。使用一般估计方程来估计结核状况导致的MLR随时间的变化。在160名中位年龄为23个月的儿童中，13名（8.1%）确诊结核病，67名（41.9%）未确诊结核病。确诊结核病患儿的中位MLR[0.407（四分位间距（IQR） 0.378 ~ 0.675）]高于未确诊结核病患儿的中位MLR [0.207 (IQR 0.148 ~ 0.348), p < 0.01]或不太可能确诊结核病患儿的中位MLR [0.212 (IQR 0.138 ~ 0.391), p = 0.01]。MLR大于0.378的儿童确诊结核病的敏感性为77%，特异性为78%，阳性预测值为24%，阴性预测值为97%。结核病治疗后，确诊结核病儿童的中位MLR下降，12周后的水平与不太可能患有结核病的儿童相似。血液MLR可将确诊结核病的艾滋病毒感染儿童与不太可能患有结核病的儿童区分开来，并在结核病治疗后有所下降。在无法获得呼吸道微生物学证实的环境中，MLR可能是一种有用的结核病诊断工具。
The blood monocyte-to-lymphocyte ratio (MLR) is associated with active tuberculosis (TB) in adults, but has not been evaluated as a TB diagnostic biomarker in HIV-infected children in whom respiratory sampling is difficult. In a cohort of HIV-infected hospitalized Kenyan children initiating antiretroviral therapy, absolute monocyte and lymphocyte counts were determined at enrollment and 4, 12, and 24 weeks thereafter. Children were classified as confirmed, unconfirmed, or unlikely pulmonary TB. ROC curves of MLR cutoff values were generated to distinguish children with confirmed TB from those with unconfirmed and unlikely TB. General estimating equations were used to estimate change in MLR over time by TB status. Of 160 children with median age 23 months, 13 (8.1%) had confirmed TB and 67 (41.9%) had unconfirmed TB. Median MLR among children with confirmed TB [0.407 (interquartile range (IQR) 0.378 – 0.675)] was higher than MLR in children with unconfirmed [0.207 (IQR 0.148 – 0.348), p < 0.01] or unlikely [0.212 (IQR 0.138 – 0.391), p = 0.01] TB. MLR above 0.378 identified children with confirmed TB with 77% sensitivity, 78% specificity, 24% positive predictive value, and 97% negative predictive value. After TB treatment, median MLR declined in children with confirmed TB and levels were similar to children with unlikely TB after 12 weeks. Blood MLR distinguished HIV-infected children with confirmed TB from those with unlikely TB and declined with TB treatment. MLR may be a useful diagnostic tool for TB in settings where respiratory-based microbiologic confirmation is inaccessible.