Shima Yusuke, Masuda Takahiro, Miwa Nanako, Kida Yoko, Koketsu Rikiya, Kamiryo Hiroshi, Sakurai Toshiyasu, Tada Kimihide
Department of Respiratory Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
J Clin Tuberc Other Mycobact Dis. 2024 Apr 5;35:100437. doi: 10.1016/j.jctube.2024.100437. eCollection 2024 May.
The increasing number of patients with miliary tuberculosis (MTB) is a concern in an aging society because of its high mortality rate. Several prognostic biomarkers for MTB have been identified; however, the predictive ability of monocytes as biomarkers remains unknown. This study demonstrates the usefulness of monocytes as prognostic biomarkers for MTB.
We retrospectively compared the clinical findings of 52 patients with MTB hospitalized between April 2013 and October 2021. The predictive ability of biomarkers for 3-month prognosis and their cutoff values were calculated. Survival times and longitudinal changes in monocytes after initiating treatment were compared.
A smaller number of monocytes (#M), higher lymphocyte-monocyte ratio (LMR), higher neutrophil-monocyte ratio, and poorer performance status were associated with death within 3 months. #M was an independent prognostic factor. #M and LMR exhibited the highest predictive performance compared to others using receiver operating characteristic curve analysis (area under the curve = 0.86 and 0.85, respectively). Survival time was shorter in patients with #M ≤ 200 cells/μL and LMR > 2.5. Rapidly increasing #M after treatment was related to better prognosis in patients with #M ≤ 200 cells/μL at diagnosis.
#M at diagnosis and longitudinal changes in monocytes are related to MTB prognosis.
在老龄化社会中，粟粒性肺结核（MTB）患者数量的增加令人担忧，因为其死亡率很高。已经确定了几种MTB的预后生物标志物；然而，单核细胞作为生物标志物的预测能力仍然未知。本研究证明了单核细胞作为MTB预后生物标志物的有用性。
我们回顾性比较了2013年4月至2021年10月期间住院的52例MTB患者的临床资料。计算了生物标志物对3个月预后的预测能力及其临界值。比较了开始治疗后单核细胞的生存时间和纵向变化。
单核细胞数量较少（#M）、淋巴细胞与单核细胞比值（LMR）较高、中性粒细胞与单核细胞比值较高以及体能状态较差与3个月内死亡相关。#M是一个独立的预后因素。使用受试者工作特征曲线分析，与其他因素相比，#M和LMR表现出最高的预测性能（曲线下面积分别为0.86和0.85）。#M≤200个细胞/μL且LMR>2.5的患者生存时间较短。诊断时#M≤200个细胞/μL的患者，治疗后#M迅速增加与较好的预后相关。
诊断时的#M和单核细胞的纵向变化与MTB预后相关。
