HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Int J Tuberc Lung Dis. 2021 Nov 1;25(11):933-938. doi: 10.5588/ijtld.21.0300.
Diagnostic tools to identify incipient or subclinical TB stages will be helpful for preventive intervention. A simple biomarker to predict TB may be the monocytes to lymphocytes ratio (ML ratio) in peripheral blood. We assessed the relationship between multiple time-updated ML ratio measurements and incidence of TB in people living with HIV (PLWH) after antiretroviral therapy (ART) was initiated. The ML ratio was updated at least every 6 months. TB incidence with corresponding 95% confidence intervals stratified according to time-updated ML ratio was calculated using ML ratio in quartiles. A total of 1305 PLWH were included in the analyses: 46 had incident TB and 1259 remained TB-free. The TB incidence rate was 10.3 (95% CI 7.1-14.9) cases/1000 patient-years (PYR) among participants with ML ratio ≥0.25 compared with 1.1/1000 PYR (95% CI 0.4-2.9) among those with ML ratio <0.15. At cut-point 0.23, the ML ratio provided a diagnostic area under the receiver operating characteristics curve (AROC) of 0.849 (95% CI 0.784-0.914) and a sensitivity of 85% and specificity of 71%. Increased ML ratio was predictive of incident TB among PLWH on or after ART. The ML ratio can be a simple tool to stratify the risk of TB in PLWH.
诊断工具来识别初期或亚临床结核病阶段将有助于预防干预。一种简单的预测结核病的生物标志物可能是外周血中的单核细胞与淋巴细胞比值（ML 比值）。我们评估了在开始抗逆转录病毒治疗（ART）后，多个时间更新的 ML 比值测量与 HIV 感染者（PLWH）结核病发病之间的关系。ML 比值至少每 6 个月更新一次。根据 ML 比值四分位距计算按时间更新 ML 比值分层的 TB 发生率及其相应的 95%置信区间。共纳入 1305 例 PLWH 进行分析：46 例发生结核病，1259 例未发生结核病。ML 比值≥0.25的参与者中，TB 发病率为 10.3（95%CI7.1-14.9）例/1000 患者年（PYR），而 ML 比值<0.15 的参与者中，TB 发病率为 1.1/1000PYR（95%CI0.4-2.9）。在截断值 0.23 时，ML 比值提供了 0.849（95%CI0.784-0.914）的接收者操作特征曲线（ROC）下面积（AUC）和 85%的敏感性和 71%的特异性。在开始 ART 或之后的 PLWH 中，ML 比值增加预示着结核病的发生。ML 比值可以作为一种简单的工具来分层 PLWH 结核病的风险。
