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已发表论文
单核细胞与淋巴细胞比值及预后营养指数在诊断涂片阴性且结核感染 T 细胞检测阴性的肺结核中的临床应用价值
Authors Liu Y, Li M, Ding Y, Gao Y, Li T, Wang X, Zheng M
Received 17 July 2025
Accepted for publication 27 October 2025
Published 5 November 2025 Volume 2025:18 Pages 5731—5743
DOI https://doi.org/10.2147/IDR.S554475
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Hemant Joshi
Yan Liu,1– 3 Mei Li,2 Yunyun Ding,2 Yong Gao,2 Tuantuan Li,2 Xiaowu Wang,2 Meijuan Zheng1
1Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Department of Clinical Laboratory, The Second People’s Hospital of Fuyang City, Fuyang, People’s Republic of China; 3Department of Clinical Laboratory, Fuyang Infection Disease Clinical College of Anhui Medical University, Fuyang, People’s Republic of China
Correspondence: Xiaowu Wang, Department of Clinical Laboratory, The Second People’s Hospital of Fuyang City, Fuyang, People’s Republic of China, Email wangxiaowu19880218@126.com Meijuan Zheng, Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email mjzheng@mail.ustc.edu.cn
Objective: To evaluate the diagnostic usefulness of the monocyte-to-lymphocyte ratio (MLR) and the prognostic nutritional index (PNI) in smear-negative pulmonary tuberculosis (SN-PTB) patients with a negative interferon-γ release assay (IGRA) result.
Methods: Between January 2021 to December 2024, 548 consecutive patients suspected of having SN-PTB were enrolled at the Second People’s Hospital of Fuyang. After exclusion, 276 patients with SN-PTB (SN-PTB group) and 272 with non-tuberculous (Non-TB) pulmonary infection (Non-TB group) were retrospectively analyzed. Laboratory parameters—including albumin (ALB), pre-albumin (PALB), C-reactive protein (CRP), fibrinogen (FIB), IGRA result, T-cell subsets (CD3+, CD4+, CD8+), CD4+/CD8+ ratio, MLR, and neutrophil-to-lymphocyte ratio (NLR)—were compared between groups. Patients were further stratified by IGRA status (positive vs negative). Receiver-operating characteristic (ROC) curves were constructed to assess the diagnostic performance of individual and combined indices.
Results: In the IGRA-negative subgroup (SN-PTB group: n = 25; Non-TB group: n = 184), MLR was significantly higher in the SN-PTB group (p = 0.008) and PNI was significantly lower (p < 0.001). No significant differences were observed in ALB, FIB, CRP, PALB, or T-cell subsets in this subgroup. The combination of MLR and PNI—using a logistic regression-derived score—achieved the best discriminatory power, with an area under the ROC curve (AUROC) of 0.718 (95% CI: 0.656– 0.774), sensitivity of 60.00%, and specificity of 82.38% at the optimal cut-off value.
Conclusion: MLR, PNI and their combination offer moderate diagnostic value for SN-PTB when the IGRA result is negative; the combined MLR+PNI index performs better than either marker alone. However, these findings should be interpreted with caution due to the limited sample size in the IGRA-negative subgroup, and further validation in larger cohorts is warranted.
Keywords: smear-negative pulmonary tuberculosis, interferon-gamma release assay, MLR, PNI, diagnostic value
1Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Department of Clinical Laboratory, The Second People’s Hospital of Fuyang City, Fuyang, People’s Republic of China; 3Department of Clinical Laboratory, Fuyang Infection Disease Clinical College of Anhui Medical University, Fuyang, People’s Republic of China
Correspondence: Xiaowu Wang, Department of Clinical Laboratory, The Second People’s Hospital of Fuyang City, Fuyang, People’s Republic of China, Email wangxiaowu19880218@126.com Meijuan Zheng, Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email mjzheng@mail.ustc.edu.cn
Objective: To evaluate the diagnostic usefulness of the monocyte-to-lymphocyte ratio (MLR) and the prognostic nutritional index (PNI) in smear-negative pulmonary tuberculosis (SN-PTB) patients with a negative interferon-γ release assay (IGRA) result.
Methods: Between January 2021 to December 2024, 548 consecutive patients suspected of having SN-PTB were enrolled at the Second People’s Hospital of Fuyang. After exclusion, 276 patients with SN-PTB (SN-PTB group) and 272 with non-tuberculous (Non-TB) pulmonary infection (Non-TB group) were retrospectively analyzed. Laboratory parameters—including albumin (ALB), pre-albumin (PALB), C-reactive protein (CRP), fibrinogen (FIB), IGRA result, T-cell subsets (CD3+, CD4+, CD8+), CD4+/CD8+ ratio, MLR, and neutrophil-to-lymphocyte ratio (NLR)—were compared between groups. Patients were further stratified by IGRA status (positive vs negative). Receiver-operating characteristic (ROC) curves were constructed to assess the diagnostic performance of individual and combined indices.
Results: In the IGRA-negative subgroup (SN-PTB group: n = 25; Non-TB group: n = 184), MLR was significantly higher in the SN-PTB group (p = 0.008) and PNI was significantly lower (p < 0.001). No significant differences were observed in ALB, FIB, CRP, PALB, or T-cell subsets in this subgroup. The combination of MLR and PNI—using a logistic regression-derived score—achieved the best discriminatory power, with an area under the ROC curve (AUROC) of 0.718 (95% CI: 0.656– 0.774), sensitivity of 60.00%, and specificity of 82.38% at the optimal cut-off value.
Conclusion: MLR, PNI and their combination offer moderate diagnostic value for SN-PTB when the IGRA result is negative; the combined MLR+PNI index performs better than either marker alone. However, these findings should be interpreted with caution due to the limited sample size in the IGRA-negative subgroup, and further validation in larger cohorts is warranted.
Keywords: smear-negative pulmonary tuberculosis, interferon-gamma release assay, MLR, PNI, diagnostic value