Department of Pulmonary Medicine, Istanbul Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Zeytinburnu, Turkey.
Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Fatih, Istanbul, Turkey.
Ann Thorac Med. 2014 Oct;9(4):232-5. doi: 10.4103/1817-1737.140135.
The differential diagnosis of sarcoidosis creates a challange due to tuberculosis also having lung and lymph node involvement. Because both diseases show granulomatous inflammation, it may not be possible to distinguish tuberculosis and sarcoidosis in pathological specimens. As a result of the complexity in the differential diagnosis of sarcoidosis and tuberculosis, new markers for differentiation are being investigated.
The aim of our study is to investigate the value of neutrophil/lymphocyte ratio (NLR) as a possible marker in differentiating sarcoidosis and tuberculosis.
In our study, 51 acid-fast bacilli (AFB) positive and/or culture-positive patients with pulmonary tuberculosis, 40 patients with biopsy-proven sarcoidosis and a control group consisting of 43 patients were included. In our study, information was collected retrospectively based on hospital records.
Leukocyte and neutrophil counts, NLR, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were significantly higher, and albumin was significantly lower in the tuberculosis group compared with sarcoidosis (for all parameters P < 0.001). The most appropriate cut-off value of NLR to distinguish tuberculosis from sarcoidosis was determined as 2.55. For this cut-off value of NLR there was 79% sensitivity, 69% specificity, 73% positive predictive value (PPV), 75% negative predictive value (NPV), and area under the curve (AUC) was 0.788. For differentiation of sarcoidosis from tuberculosis, accuracy of the NLR test according to this cut-off value was found as 76%.
NLR as a little known marker in respiratory medicine was found to be supportive in differentiation of tuberculosis and sarcoidosis. More studies on this issue is needed.
由于肺结核也会累及肺部和淋巴结，因此在鉴别诊断结节病时会带来挑战。由于这两种疾病都表现为肉芽肿性炎症，因此在病理标本中可能无法区分肺结核和结节病。由于结节病和肺结核的鉴别诊断复杂，因此正在研究新的鉴别标记物。
本研究旨在探讨中性粒细胞/淋巴细胞比值（NLR）作为鉴别结节病和肺结核的可能标志物的价值。
在我们的研究中，纳入了 51 例抗酸杆菌（AFB）阳性和/或培养阳性的肺结核患者、40 例经活检证实的结节病患者和一个对照组，共 43 例患者。在我们的研究中，信息是根据医院记录进行回顾性收集的。
与结节病组相比，肺结核组的白细胞和中性粒细胞计数、NLR、红细胞沉降率（ESR）、C 反应蛋白（CRP）显著升高，白蛋白显著降低（所有参数 P<0.001）。确定 NLR 区分肺结核和结节病的最佳截断值为 2.55。对于这个 NLR 截断值，有 79%的敏感性、69%的特异性、73%的阳性预测值（PPV）、75%的阴性预测值（NPV）和曲线下面积（AUC）为 0.788。对于结节病和肺结核的鉴别，根据该 NLR 截断值，NLR 检测的准确性为 76%。
NLR 作为呼吸医学中一个鲜为人知的标志物，被发现有助于区分肺结核和结节病。需要对此问题进行更多的研究。
