Clinical Application Of Blood Cell VCS Parameters In Diagnosis Of Active Pulmonary Tuberculosis

Background : Tuberculosis(TB)is a chronic infectious disease caused by mycobacterium tuberculosis(MTB).One-third of the world's population is latent tuberculosis infection(LTBI),of which 5%-10% will develop as active tuberculosis,with active pulmonary tuberculosis(APTB)is the most common.China is the second most burdensome country for tuberculosis after India.The situation of tuberculosis prevention and control is very serious.The lack of effective diagnosis methods is an important reason for the prevention and control of tuberculosis.The existing tuberculosis-related laboratory tests have certain defects.For example,acid-fast staining method and bacterial culture method are the gold standards for laboratory diagnosis,but there are defects such as low positive rate and long detection time.Tuberculin skin test(TST)experiment both false positives and false negatives are high.Gamma interferon release test(IGRAs)has high sensitivity and specificity for Mycobacterium tuberculosis infection,but still cann ot distinguish between latent tuberculosis and active pulmonary tuberculosis.The morbidity and mortality rate of adult community-acquired pneumonia(CAP)in China gradually increase with age.Among the patients with community acquired pneumonia in our hospital,mainly is bacterial pneumonia.In clinical practice,pneumonia and tuberculosis often have similar symptoms,and the manifestations of inflammatory changes in imaging are similar.It is difficult to distinguish between active pulmonary tuberculosis and bacterial pneumonia,which result in patients not receiving timely treatment and delaying the disease.Therefore,there is a need of a simple,rapid and convenient method for distinguishing APTB from bacterial pneumonia for clinical diagnosis.Therefore,this study aimed to analyze the difference between APTB from LTBI and bacterial pneumonia in peripheral blood by using the cell population data(CPD),which was detected by VCS technique of DxH800.And then combined with monocyte chemotactic protein-1(MCP-1)to evaluated its diagnostic efficacy in identifying active pulmonary tuberculosis from latent tuberculosis infection and distinguishing active pulmonary tuberculosis from bacterial pneumoniaMethods: 1,97 cases of active pulmonary tuberculosis,112 cases of tuberculosis latent infection,101 cases of healthy control group were selected,and obtained peripheral vein EDTA-K2,heparin sodium anticoagulated and procoagulant whole blood by vein,all EDTA-K2 anticoagulated samples were detected by DxH800 and the VCS related parameters of peripheral blood cells were obtained.The expression level of cytokine MCP-1 and the ?-interferon release in plasma were detected by ELISA kits.Statistical methods were used to compare the differences among the three groups,and screened out the parameters that can be used to diagnose APTB and identify APTB from LTBI.The area under the ROC curve were used to evaluate the diagnostic efficacy of each parameter and multi-parameters for identifying APTB from LTBI.2,68 cases of active pulmonary tuberculosis,56 cases of bacterial pneumonia,89 cases of healthy controls' peripheral venous anticoagulation whole blood were collected,all samples were detected by DxH800 automatic blood analyzer,and VCS related parameters of white blood population were obtained.Statistical analysis of the differences among the three groups,and the VCS parameters with significant differences between active pulmonary tuberculosis and bacterial pneumonia were screened.The diagnostic efficacy of each parameter and multi-parameter were evaluated from the area under curve(AUC).Result:1,There are total of 47 parameters in the APTB group compared with the LTBI and HC,25 parameters significantly increased,a significant reduction of 11 parameters,and 11 parameters were not statistically different.Through analysis by the Cutoff value,we obtained the optimal diagnostic sensitivity and specificity of each parameter.Among them,there were 11 parameters under the ROC curve with an area larger than 0.8.Monocyte difference is most significant.Simultaneously measuring the mean monocyte volume(MMV)with its standard deviation(MMV-SD),mean monocyte conductivity(MMC)and monocyte chemoattractant protein-1(MCP-1),the area under the ROC curve was 0.973,the sensitivity was 93.8%,and the specificity was 93.1%,which obtained a better diagnostic efficacy in distinguishing between active pulmonary tuberculosis and latent tuberculosis infection.2.In the same way,there were 46 parameters for identifying active pulmonary tuberculosis and bacterial pneumonia,22 parameters were significantly elevated in the tuberculosis group,11 parameters were significantly reduced,13 parameters were no statistically significant differences between the active pulmonary tuberculosis group and the bacterial pneumonia group.There were 12 parameters which the area under the ROC curve were higher than 0.8,and even the neutrophil mean conductivity(NMC),monocyte mean conductivity(MMC)as a single indicator for distinguishing active pulmonary tuberculosis and bacterial pneumonia had a good result,which reached 0.939 and 0.98 under the ROC curve,respectively.We screened NMC,MMV,and MMC parameters for combined parameters,of which the area under the ROC curve was as high as 0.99,the sensitivity was 98.5%,the specificity was 91.1%.These parameters which used to distinguish active pulmonary tuberculosis from bacterial pneumonia has higher diagnostic efficiency.Conclusions:Rapid diagnosis of active pulmonary tuberculosis from latent tuberculosis bacterial pneumonia are currently urgent problem to be solved.This study shows that Monocyte cell VCS parameters combined with MCP-1 can distinguish active pulmonary tuberculosis from latent tuberculosis and Monocyte combined neutrophil cell VCS parameters can distinguish active pulmonary tuberculosis from bacterial pneumonia with good sensitivity and specificity.it may provide valuable diagnostic indicators for clinical.