中性粒细胞百分比、血红蛋白及D-二聚体联合检测在肺结核合并结核性多浆膜腔积液中的诊断价值分析

doi:10.19871/j.cnki.xfcrbzz.2025.04.006

摘要/Abstract

摘要： 目的通过分析肺结核合并结核性多浆膜腔积液患者的临床资料及中性粒细胞百分比（neutrophil percentage,NEUT）、血红蛋白（hemoglobin,HGB）及D-二聚体（D-dimer,D-D）联合检测的诊断效能,早期识别肺结核合并结核性多浆膜腔积液患者,指导临床优化抗结核治疗方案。方法选取2022年7月至2024年6月安徽省胸科医院收治的138例肺结核合并结核性多浆膜腔积液患者纳入观察组,同期住院治疗的单纯肺结核患者146例为对照组。对两组患者的临床资料以及NEUT、HGB、D-D、血小板（blood platelet,PLT）计数、红细胞沉降率（erythrocyte sedimentation rate,ESR）、血清白蛋白（serum albumin,ALB）、超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）等实验室检查结果进行单因素分析,单因素分析有统计学意义的因素纳入多因素Logistic回归分析模型。采用受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）分析各影响因素对肺结核合并结核性多浆膜腔积液的诊断效能。结果观察组和对照组患者一般资料（年龄、糖尿病、居住地、职业、婚姻情况、性别、高血压、诊断类型）差异无统计学意义（P>0.05)。两组患者白细胞 (white blood cell count, WBC）计数差异无统计学意义（P>0.05）,NEUT、HGB含量、PLT计数、ESR、ALB浓度、hs-CRP浓度及D-D水平差异有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示：NEUT、D-D水平升高是肺结核合并结核性多浆膜腔积液患者的危险因素,高水平HGB是肺结核合并结核性多浆膜腔积液患者的保护因素（均P<0.05）。ROC曲线分析：在单项指标检测结果中,D-D的AUC值最大为0.871,NEUT、HGB、D-D三者联合预测的AUC值为0.908（95%CI：0.873~0.942）,敏感度为84.8%,特异度为83.6%,约登指数为0.684。结论 NEUT、D-D水平升高是肺结核合并结核性多浆膜腔积液患者的危险因素,高水平HGB是肺结核合并结核性多浆膜腔积液患者的保护因素,NEUT、HGB、D-D三者联合预测模型对发生肺结核合并结核性多浆膜腔积液具有较高的诊断效能。

关键词: 肺结核, 结核性多浆膜腔积液, 中性粒细胞百分比, 血红蛋白, D-二聚体, 影响因素分析, 诊断价值

Abstract: Objective By analyzing the clinical data and the diagnostic efficacy of combined detection of neutrophil percentage (NEUT), hemoglobin (HGB) and D-dimer (D-D) in patients with tuberculosis combined with tuberculous pleural effusion, this study aims to identify patients with tuberculosis combined with tuberculous pleural effusion at an early stage and to guide the optimization of clinical anti-tuberculosis treatment. Method A total of 138 patients with pulmonary tuberculosis combined with tuberculous polyserositis, admitted to Anhui Chest Hospital from July 2022 to June 2024, were included as the observation group. Additionally, 146 patients with simple pulmonary tuberculosis, who were hospitalized during the same period, were included as the control group. Clinical data from two patient groups were analyzed using univariate analysis of laboratory test results including NEUT, HGB, D-D, platelet count (PLT), erythrocyte sedimentation rate (ESR), serum albumin (ALB), and hypersensitive C-reactive protein (hs-CRP). Factors demonstrating statistically significant effects were incorporated into a multivariate Logistic regression model. Receiver operating characteristics (ROC) curves were employed to evaluate diagnostic efficacy of these factors in diagnosing pulmonary tuberculosis complicated by tuberculous pleural effusion. Result There were no significant differences in the general characteristics between the observation group and the control group(age, diabetes, place of residence, occupation, marital status, gender, hypertension, type of diagnosis). There was no significant difference in white blood cell count levels between the two groups (P>0.05), while neutrophilpercentage, hemoglobin, blood platelet, ESR, serum albumin, hs-CRP, D-D showed statistically significant differences (P<0.05). The results of multi-factor Logistic regression analysis showed that NEUT and D-D levels are risk factors for patients with pulmonary tuberculosis combined with tuberculous serous cavity effusion, and high HGB levels are protective factors for patients with pulmonary tuberculosis combined with tuberculous serous cavity effusion. ROC curve analysis revealed that, among the individual indicators, D-D had the highest AUC value of 0.871.The combined detection of neutrophil percentage, hemoglobin and D-dimer had an AUC value of 0.908 (95%CI: 0.873-0.942), with a sensitivity of 84.8%, a specificity of 83.6%, and a Youden index of 0.684. Conclusion NEUT and D-D levels are risk factors for patients with pulmonary tuberculosis combined with tuberculous serous cavity effusion, whereas high HGB levels are protective factors for patients with pulmonary tuberculosis combined with tuberculous serous cavity effusion, and the combined prediction model of NEUT, HGB and D-D has a high diagnostic efficacy for dentifying pulmonary tuberculosis combined with tuberculous serous cavity effusion.

Key words: Pulmonary tuberculosis, Tuberculous polyserositis, Neutrophil percentage, Hemoglobin, D-dimer, Analysis of influencing factors, Diagnostic value

中图分类号:

R521
R181

刘晓宁, 唐飞, 梅恒, 刘盛盛, 章鑫丽, 张良柱, 马方方, 李晔. 中性粒细胞百分比、血红蛋白及D-二聚体联合检测在肺结核合并结核性多浆膜腔积液中的诊断价值分析[J]. 新发传染病电子杂志, 2025, 10(4): 34-39.

Liu Xiaoning, Tang Fei, Mei Heng, Liu Shengsheng, Zhang Xinli, Zhang Liangzhu, Ma Fangfang, Li Ye. Diagnostic Value of combined detection of neutrophil percentage, hemoglobin, and D-dimer in pulmonary tuberculosis with tuberculous polyserositis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(4): 34-39.

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