Diagnostic value of laboratory indexes in patients with pulmonary tuberculosis complicated by pulmonary embolism

doi:10.3969/j.issn.1004-583X.2024.02.007

Abstract

Abstract:

Objective To investigate the diagnostic value of laboratory indicators in patients with pulmonary tuberculosis (PTB) complicated by pulmonary embolism (PE), and to provide evidence for the patients. Methods Sixty inpatients with PTB and PE in our hospital from January 2019 to December 2021 were selected as the observation group. In addition, 60 patients with simple PTB matched according to 1∶1 ratio were selected as the control group. The differences in general information and related laboratory data between the two groups were observed. Binary logistic regression was used to analyze the risk factors, and the receiver operating characteristic (ROC) curve was drawn for meaningful indicators to evaluate their diagnostic value. Results The levels of white blood cells, neutrophils, C-reactive protein and procalcitonin in the observation group were significantly higher than those of the control group (P<0.05). Biochemical indicators including D-dimer, fibrinogen, troponin I, myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP) in the observation group were significantly higher than those in the control group (P<0.05). The lymphocyte, albumin, high density lipoprotein cholesterol, oxygen partial pressure and antithrombin Ⅲ in the observation group were significantly lower than those of the control group (P<0.05). The results from binary logistic regression analysis showed that D-dimer, antithrombin Ⅲ and NT-proBNP were risk factors for PTB with PE (OR=1.302, 0.957, 1.012). The area under the curve (AUC) of D-dimer, antithrombin Ⅲ and NT-proBNP was 0.858, 0.711 and 0.831, respectively. Conclusion D-dimer>1.29 mg/L, antithrombin Ⅲ<101.6%, NT-proBNP >99.79 ng/L have certain predictive value for PE in patients with PTB, which can be used as an important index to predict PE and evaluate the prognosis of patients with PTB.

Key words: tuberculosis, pulmonary, pulmonary embolism, d-dimer, antithrombin Ⅲ

CLC Number:

R521

Liu Lei, Li Mingwu, Wan Rong. Diagnostic value of laboratory indexes in patients with pulmonary tuberculosis complicated by pulmonary embolism[J]. Clinical Focus, 2024, 39(2): 134-139.

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http://www.lchc.cn/EN/Y2024/V39/I2/134

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References 28

[1]	中华医学会呼吸病学分会. 肺栓塞与肺血管病学组.肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14):1060-1087.
[2]	李丹丹, 辛涛, 姜华, 等. 肺结核合并肺栓塞1例[J]. 中华肺部疾病杂志(电子版), 2019, 12(2):244-246.
[3]	中华人民共和国国家卫生和计划生育委员会. 肺结核诊断标准(WS 288-2017)[J]. 新发传染病电子杂志, 2018, 3(1):59-61.
[4]	World Health Organization. 2021.Geneva: 2021. Global tuberculosis report 2021[EB/OL].https://www.who.int/publications/i/item/9789240037021.
[5]	Zahra U, Akhtar A, Falah NU, et al. Bilateral pulmonary embolism in a newly diagnosed case of pulmonary tuberculosis[J]. Cureus, 2021, 13(1):e12824.
[6]	Howard L. Acute pulmonary embolism[J]. Clin Med (Lond), 2019, 19(3):243-247. doi: 10.7861/clinmedicine.19-3-247 pmid: 31092519
[7]	沈甜, 朱慧明, 田华, 等. 外周血PCT、CRP、FIB、D-D水平对肺结核合并细菌性肺炎的早期诊断价值[J/OL]. 中国热带医学:1-6[2024-03-22].http://kns.cnki.net/kcms/detail/46.1064.R.20230613.1033.002.html.
[8]	李宝平, 陈东进, 孙治平, 等. 尘肺结核相关实验室检查方法对比分析[J]. 工业卫生与职业病, 2017, 43(4):256-259, 264.
[9]	Liu R, Shu W, Song Y, et al. Use of serum albumin level as a predictive marker of clinical outcomes for active tuberculosis[J]. Ann Clin Lab Sci, 2020, 50(5):681-686. pmid: 33067216
[10]	Li Y, Yang F, Zhou H, et al. Clinical application of nrs-2002 in nutritional risk screening of tuberculosis inpatients[J]. Ann Palliat Med, 2021, 10(5): 5322-5328. doi: 10.21037/apm URL
[11]	黄平, 李玉红, 刘汉芸, 等. 单核细胞与淋巴细胞比值及预后营养指数对菌阴肺结核的辅助诊断价值[J]. 中国现代医学杂志, 2022, 32(10):93-97.
[12]	陈安琪, 高悦, 吴云. 新型炎症指标对急性肺栓塞的诊断价值[J]. 临床肺科杂志, 2023, 28(4):579-584.
[13]	李玉环, 王希, 李彤彤. 血浆D-二聚体、纤维蛋白原在老年社区获得性肺炎合并肺栓塞中的临床诊断价值[J]. 中国老年学杂志, 2023 43(5):1083-1085.
[14]	郭文亮, 陈海明, 伍晓锋, 等. 抗凝血酶Ⅲ活性减低诱发球囊肺动脉成形术后肺栓塞1例[J]. 中华心血管病杂志, 2023, 51(1):76-79.
[15]	Barco S, Mahmoudpour SH, Planquette B, et al. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: A systematic review and meta-analysis[J]. Eur Heart J, 2019, 40(11):902-910. doi: 10.1093/eurheartj/ehy873 pmid: 30590531
[16]	罗昊天, 张中星, 陈虹. 肺栓塞合并肺结核患者的临床特征[J]. 医药前沿, 2018, 8(14):87-88.
[17]	Gok M, Kurtul A. A novel marker for predicting severity of acute pulmonary embolism: Systemic immune-inflammation index[J]. Scand Cardiovasc J, 2021, 55(2):91-96. doi: 10.1080/14017431.2020.1846774 pmid: 33263444
[18]	Hao Z, Wei J, Li X, et al. Inflammation-associated D-dimer predicts neurological outcome of recent small subcortical infarct: A prospective clinical and laboratory study[J]. Clin Neurol Neurosurg, 2024, 237:108126. doi: 10.1016/j.clineuro.2024.108126 URL
[19]	Borowiec A, Dᶏbrowski R, Kowalik I, et al. Elevated levels of d-dimer are associated with inflammation and disease activity rather than risk of venous thromboembolism in patients with granulomatosis with polyangiitis in long term observation[J]. Adv Med Sci, 2020, 65(1):97-101. doi: 10.1016/j.advms.2019.12.007 URL
[20]	Nasif WA, El-Moursy Ali AS, Hasan Mukhtar M, et al. Elucidating the correlation of D-dimer levels with COVID-19 severity: A scoping review[J]. Anemia, 2022, 2022:9104209.
[21]	汤炜, 许超. 重症肺炎患者血浆N末端脑钠肽前体、D-二聚体水平与炎症因子及预后的关系[J]. 国际检验医学杂志, 2020 41(3):297-300, 304.
[22]	宫芳芳. 血清中D-dimer水平在重症肺炎支原体肺炎中的临床意义[D]. 十堰: 湖北医药学院, 2022.
[23]	Danwang C, Bigna JJ, Awana AP, et al. Global epidemiology of venous thromboembolism in people with active tuberculosis: A systematic review and meta-analysis[J]. J Thromb Thrombolysis, 2021, 51(2):502-512. doi: 10.1007/s11239-020-02211-7
[24]	Nkoke C, Teuwafeu D, Mapina A, et al. A case series of venous thromboembolic disease in a semi-urban setting in Cameroon[J]. BMC Res Notes, 2019, 12(1):40. doi: 10.1186/s13104-019-4092-8 pmid: 30658695
[25]	龚学全. 百合知母汤辅助治疗对老年肺结核患者的影响[J]. 实用中西医结合临床, 2022 22(3):17-19, 41.
[26]	高标, 马凡尼, 李相磊. 外周血血小板参数、抗凝血酶-Ⅲ表达水平在急性肺栓塞患者中的临床意义[J]. 中国卫生检验杂志, 2021 31(1):69-72.
[27]	Zhang YW, Wu D, Zhu ZZ, et al. Analysis of the imaging features and prognosis of pulmonary tuberculosis complicated with pulmonary embolism[J]. Curr Med Imaging, 2024, 20: e310323215270.
[28]	何伟荣, 王海, 张棋荣, 等. 320排CT肺血管减影成像联合NT-proBNP诊断急性肺栓塞的临床应用[J]. 中国医学创新, 2021, 18(33):137-140.

组别	例数	性别 (男/女)	年龄 (岁)	病原学阳性 [例(%)]	合并COPD [例(%)]	合并高血压 [例(%)]	合并呼吸衰竭 [例(%)]	合并糖尿病 [例(%)]
观察组	60	(32/28)	60.00(52.00,66.00)	37(61.7)	19(31.7)	5(8.3)	7(11.7)	2(3.3)
对照组	60	(41/19)	64.50(51.50,72.00)	27(45.0)	14(23.3)	2(3.3)	3(5.0)	3(5.0)
Z/χ²值		3.104	-1.816	2.715	0.935	0.572	0.928	0.227
P值		0.078	0.069	0.099	0.333	0.449	0.335	0.634

组别	例数	性别 (男/女)	年龄 (岁)	病原学阳性 [例(%)]	合并COPD [例(%)]	合并高血压 [例(%)]	合并呼吸衰竭 [例(%)]	合并糖尿病 [例(%)]
观察组	60	(32/28)	60.00(52.00,66.00)	37(61.7)	19(31.7)	5(8.3)	7(11.7)	2(3.3)
对照组	60	(41/19)	64.50(51.50,72.00)	27(45.0)	14(23.3)	2(3.3)	3(5.0)	3(5.0)
Z/χ²值		3.104	-1.816	2.715	0.935	0.572	0.928	0.227
P值		0.078	0.069	0.099	0.333	0.449	0.335	0.634

组别	例数	WBC (×10⁹/L)	LY (×10⁹/L)	NE (×10⁹/L)	RBC (×10¹²/L)	Hb (g/L)	PLT (×10⁹/L)	白蛋白 (g/L)	球蛋白 (g/L)
观察组	60	7.11(5.15,10.33)	0.83(0.56,1.38)	5.14(3.78,8.57)	4.14±0.62	125.10±21.58	225.00(158.25,341.00)	29.90(26.20,33.40)	29.40(25.30,35.80)
对照组	60	5.66(4.52,7.21)	1.48(1.14,1.92)	3.35(2.47,4.89)	4.38±0.81	132.59±19.51	224.00(184.00,324.00)	35.70(28.03,38.10)	29.70(26.40,36.83)
Z/t值		-2.648	-4.735	-3.897	1.832	0.823	-0.770	-4.927	-1.325
P值		0.008	<0.01	<0.01	0.070	0.052	0.441	<0.01	0.185

组别	例数	WBC (×10⁹/L)	LY (×10⁹/L)	NE (×10⁹/L)	RBC (×10¹²/L)	Hb (g/L)	PLT (×10⁹/L)	白蛋白 (g/L)	球蛋白 (g/L)
观察组	60	7.11(5.15,10.33)	0.83(0.56,1.38)	5.14(3.78,8.57)	4.14±0.62	125.10±21.58	225.00(158.25,341.00)	29.90(26.20,33.40)	29.40(25.30,35.80)
对照组	60	5.66(4.52,7.21)	1.48(1.14,1.92)	3.35(2.47,4.89)	4.38±0.81	132.59±19.51	224.00(184.00,324.00)	35.70(28.03,38.10)	29.70(26.40,36.83)
Z/t值		-2.648	-4.735	-3.897	1.832	0.823	-0.770	-4.927	-1.325
P值		0.008	<0.01	<0.01	0.070	0.052	0.441	<0.01	0.185

组别	例数	HDL-C(mmol/L)	LDL(mmol/L)	PaO₂(mmHg)	PaCO₂(mmHg)
观察组	60	0.70(0.54,0.94)	2.42±0.92	66.00(57.00,86.50)	36.00(32.00,41.25)
对照组	60	1.06(0.86,1.30)	2.56±0.83	93.00(89.00,95.00)	35.00(28.33,39.00)
Z/t值		-4.252	0.705	-4.696	-0.629
P值		<0.01	0.482	<0.01	0.529