在诊断结核病时,C反应蛋白和差异化白细胞计数的准确性
Gideon Ruder1, Richard M N Carter1, Gina Joubert2
1Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Southern African journal of infectious diseases
|June 9, 2023
概括
在住院患者中,C-反应蛋白 (CRP) 和白细胞计数 (WCC) 并不是有效的结核病 (TB) 查工具. 这些标志物没有达到世卫组织对结核病查的目标,这表明在这个患者群体中的效用有限.
科学领域:
- 临床医学 临床医学
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 结核病 (TB) 仍然是一个重大的公共卫生挑战,特别是在南非,那里有很大一部分肺结核病被微生物学证实.
- 尸体解剖研究显示,艾滋病毒阳性个体中未被诊断的结核病例的比例很高,这凸显了改善查策略的必要性.
研究的目的:
- 评估C反应蛋白 (CRP) 和分化白细胞计数 (WCC) 的实用性,包括各种比率,作为住院成年患者肺结核 (TB) 查工具.
- 确定这些炎症标志物是否能够有效地在医院环境中识别结核病例,特别是在艾滋病毒联合感染的背景下.
主要方法:
- 进行了一项回顾性横截面研究,涉及2016年4月至2019年9月期间在Bloemfontein的两个三级医院接受治疗的1294名成年患者.
- 实验室数据来自国家卫生实验室服务 (NHLS),结核病诊断证实使用Xpert® MTB/RIF,Xpert® MTB/RIF Ultra和结核病培养作为参考标准.
主要成果:
- 研究人口包括15.1%的结核病患者,其中63.1%是艾滋病毒阳性. 结核病患者明显年轻.
- 虽然某些WCC参数 (总数,中性粒细胞,淋巴细胞) 和CRP-WCC比率在结核病患者和非结核病患者之间显示出统计学上显著的差异,但没有一个达到世界卫生组织对敏感性和特异性的查目标.
- 这些发现在艾滋病毒阳性患者的小组中是一致的,在结核病患者中,WCC,中性粒细胞和淋巴细胞数量较低,CRP-WCC比率更高,但仍然不足以查.
结论:
- 不同化的白细胞计数 (WCC) 和C反应蛋白 (CRP) 不是有效的查工具结核病 (TB) 在住院患者在这个南非设置.
- 这项研究表明,目前的炎症标志物缺乏必要的准确性,不能作为结核病的独立查工具,特别是在晚期艾滋病患者中.
- 未来的研究应该专注于开发和验证新的查算法,以改善结核病的早期检测和诊断.
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