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全血细胞计数参数和血清电解质水平对儿童肺结核与社区获得性肺炎的鉴别诊断有预测作用吗?

Can Complete Blood Count Parameters and Serum Electrolyte Levels Have a Predictive Role in Differential Diagnosis of Tuberculosis from Community-acquired Pneumonia in Children?

作者信息

Aygün Deniz, Önal Pınar, Kılınç Ayşe Ayzıt, Aygün Fatih, Şiraneci Rengin, Çokuğraş Haluk

机构信息

Department of Pediatric Infectious Diseases, Kanuni Sultan Süleyman Research and Training Hospital, İstanbul, Türkiye.

Department of Pediatric Infectious Diseases, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Türkiye.

出版信息

Turk Arch Pediatr. 2024 May 2;59(3):289-295. doi: 10.5152/TurkArchPediatr.2024.24015.

Abstract

The complete blood count (CBC) parameters and the ratios regarding these parameters have been demonstrated to be useful diagnostic biomarkers for many infectious diseases. Herein, we aimed to evaluate and compare the usefulness of the predictive role of the CBC in the differential diagnosis of pulmonary tuberculosis (TB) from community-acquired pneumonia (CAP) in children. We also compared serum electrolyte levels between the 2 diseases. In this retrospective study, we analyzed the efficacy of CBC parameters and neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), plateletto-lymphocyte ratio (PLR), neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), and serum electrolyte levels in the differential diagnosis of pulmonary TB from CAP in children. We also classified patients with TB into 2 groups according to the microbiologic confirmation. We investigated whether there is any difference regarding these parameters in patients with positive microbiologic results. A total of 163 patients diagnosed with TB and CAP were included in this study. The WBC, neutrophil and monocyte counts, NLR, MLR, NMLR, mean platelet volume (MPV), and C-reactive protein (CRP) values were higher in CAP. There was statistical significance among serum sodium and phosphorus (P) levels between the 2 groups. Microbiologic confirmation was determined in 37 (35.5%) patients with the diagnosis of TB. The NLR, MLR, NMLR, CRP, and P values were significantly higher in patients with microbiologic confirmation. The results of the present study suggest that complete blood count parameters, NLR, MLR, NMLR, and CRP can be useful and cost-effective markers in differentiating pulmonary TB from CAP in the early stages of diagnosis.

摘要

全血细胞计数(CBC)参数以及这些参数的比值已被证明是许多传染病有用的诊断生物标志物。在此,我们旨在评估和比较CBC在儿童肺结核(TB)与社区获得性肺炎(CAP)鉴别诊断中的预测作用的有用性。我们还比较了这两种疾病之间的血清电解质水平。在这项回顾性研究中,我们分析了CBC参数、中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、血小板与淋巴细胞比值(PLR)、中性粒细胞与单核细胞加淋巴细胞比值(NMLR)以及血清电解质水平在儿童肺结核与CAP鉴别诊断中的功效。我们还根据微生物学确诊情况将肺结核患者分为两组。我们调查了微生物学结果呈阳性的患者在这些参数方面是否存在差异。本研究共纳入163例诊断为肺结核和CAP的患者。CAP患者的白细胞、中性粒细胞和单核细胞计数、NLR、MLR、NMLR、平均血小板体积(MPV)和C反应蛋白(CRP)值较高。两组之间血清钠和磷(P)水平存在统计学意义。确诊为肺结核的患者中有37例(35.5%)确定了微生物学确诊情况。微生物学确诊患者的NLR、MLR、NMLR、CRP和P值显著更高。本研究结果表明,全血细胞计数参数、NLR、MLR、NMLR和CRP在诊断早期区分肺结核与CAP方面可能是有用且具有成本效益的标志物。

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本文引用的文献

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Diagnostics for childhood tuberculosis: a marathon rather than a sprint.儿童结核病的诊断:一场马拉松而非短跑。
Lancet Infect Dis. 2024 Feb;24(2):110-112. doi: 10.1016/S1473-3099(23)00517-0. Epub 2023 Oct 30.
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Childhood Pneumonia: What's Unchanged, and What's New?儿童肺炎:不变与新变
Indian J Pediatr. 2023 Jul;90(7):693-699. doi: 10.1007/s12098-023-04628-3. Epub 2023 May 19.
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Significance of Hypophosphatemia in Patients with Pneumonia.肺炎患者低磷血症的意义。
Intern Med. 2022;61(7):979-988. doi: 10.2169/internalmedicine.6949-20. Epub 2022 Apr 1.
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Evaluation of clinical and laboratory characteristics of childhood tuberculosis.儿童结核病临床及实验室特征评估
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