【medical-news】JID：单核与淋巴细胞比率过高或过低的HIV感染者患结核病风险较高
发布于 2013-10-18 · 浏览 1178 · IP 黑龙江黑龙江
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Background.?Eight decades ago, the ratio ofmonocytes to lymphocytes (hereafter, the "ML ratio") was noted toaffect outcomes of mycobacterial infection in rabbits. Recent transcriptomicstudies support a role for relative proportions of myeloid and lymphoidtranscripts in tuberculosis outcomes. The ML ratio in peripheral blood is knownto be governed by hematopoietic stem cells with distinct biases.
Methods.?The predictive value of thebaseline ML ratio was modeled in 2 prospective cohorts of HIV-infected adultsstarting cART in South Africa (primary cohort, 1862 participants; replicationcohort, 345 participants). Incident tuberculosis was diagnosed with clinical,radiographic, and microbiologic methods per contemporary guidelines.Kaplan-Meier survival analyses and Cox proportional hazards modeling wereconducted.
Results.?The incidence rate of tuberculosisdiffered significantly by baseline ML ratio: 32.61 (95% confidence interval[CI], 15.38-61.54), 16.36 (95% CI, 12.39-21.23), and 51.80 (95% CI, 23.10-101.71)per 1000 patient-years for ML ratios of less than the 5th percentile, betweenthe 5th and 95th percentiles, and greater than the 95th percentile,respectively (P = .007). Neither monocyte counts nor lymphocyte counts alonewere associated with tuberculosis. After adjustment for sex, World HealthOrganization human immunodeficiency virus disease stage, CD4+ T-cell counts,and previous history of tuberculosis, hazards of disease were significantlyhigher for patients with ML ratios of less than the 5th percentile or greaterthan the 95th percentile (adjusted hazard ratio, 2.47; 95% CI, 1.39-4.40; P =.002).
Conclusions.?The ML ratio may be a useful,readily available tool to stratify the risk of tuberculosis and suggestsinvolvement of hematopoietic stem cell bias in tuberculosis pathogenesis.
Methods.?The predictive value of thebaseline ML ratio was modeled in 2 prospective cohorts of HIV-infected adultsstarting cART in South Africa (primary cohort, 1862 participants; replicationcohort, 345 participants). Incident tuberculosis was diagnosed with clinical,radiographic, and microbiologic methods per contemporary guidelines.Kaplan-Meier survival analyses and Cox proportional hazards modeling wereconducted.
Results.?The incidence rate of tuberculosisdiffered significantly by baseline ML ratio: 32.61 (95% confidence interval[CI], 15.38-61.54), 16.36 (95% CI, 12.39-21.23), and 51.80 (95% CI, 23.10-101.71)per 1000 patient-years for ML ratios of less than the 5th percentile, betweenthe 5th and 95th percentiles, and greater than the 95th percentile,respectively (P = .007). Neither monocyte counts nor lymphocyte counts alonewere associated with tuberculosis. After adjustment for sex, World HealthOrganization human immunodeficiency virus disease stage, CD4+ T-cell counts,and previous history of tuberculosis, hazards of disease were significantlyhigher for patients with ML ratios of less than the 5th percentile or greaterthan the 95th percentile (adjusted hazard ratio, 2.47; 95% CI, 1.39-4.40; P =.002).
Conclusions.?The ML ratio may be a useful,readily available tool to stratify the risk of tuberculosis and suggestsinvolvement of hematopoietic stem cell bias in tuberculosis pathogenesis.
最后编辑于 2022-10-09 · 浏览 1178
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