背景:尽管非结核性分枝杆菌肺病(NTM-PD)的发病率逐年增加,易误诊为肺结核(PTB)。本研究旨在筛选和鉴定NTM-PD与PTB的免疫学和放射学特征,并构建NTM-PD的鉴别诊断模型。为其鉴别诊断提供新的工具。
方法:将2019年1月至2023年6月期间诊断为NTM-PD或PTB的住院患者纳入研究。比较两组的免疫学和放射学特征。根据选定的差分特征,使用逻辑回归算法构建NTM-PD的判别诊断模型,并对其诊断性能进行了初步分析。
结果:NTM-PD患者的年龄明显大于PTB患者,NTM-PD组的结核特异性干扰素-γ释放试验(TB-IGRA)阳性率明显较低。此外,总T淋巴细胞的绝对计数,CD4+T淋巴细胞,CD8+T淋巴细胞,NK细胞,NTM-PD和PTB患者的B淋巴细胞明显低于健康对照组。此外,NTM-PD患者的B淋巴细胞绝对计数明显低于PTB组.放射学分析显示,NTM-PD和PTB患者在腔壁厚度方面存在显着差异,支气管扩张,肺巩固,肺结节大小,肺气肿,肺大疱,淋巴结钙化,胸腔积液,纵隔和肺门淋巴结病,和树在芽中的标志。支气管扩张被确定为NTM-PD的主要危险因素,而TB-IGRA阳性,淋巴结钙化,胸腔积液,纵隔和肺门淋巴结病是保护因素。基于此,我们构建了NTM-PD的判别诊断模型。其接收器工作特性曲线显示出良好的诊断性能,曲线下面积为0.938。在最大Youden指数0.746时,敏感性和特异性分别为0.835和0.911。
结论:NTM-PD和PTB患者表现出体液和细胞免疫功能受损以及放射学特征的显着差异。构建的NTM-PD诊断模型表现出良好的诊断性能。本研究为NTM-PD的鉴别诊断提供了新的工具。
BACKGROUND: Although the incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasing annually, it is easily misdiagnosed as pulmonary tuberculosis (PTB). This study aimed to screen and identify the immunological and radiological characteristics that differentiate NTM-PD from PTB and to construct a discriminatory diagnostic model for NTM-PD, providing new tools for its differential diagnosis.
METHODS: Hospitalised patients diagnosed with NTM-PD or PTB between January 2019 and June 2023 were included in the study. Immunological and radiological characteristics were compared between the two groups. Based on the selected differential features, a logistic regression algorithm was used to construct a discriminatory diagnostic model for NTM-PD, and its diagnostic performance was preliminarily analysed.
RESULTS: Patients with NTM-PD were significantly older than those with PTB and the tuberculosis-specific interferon-gamma release assay (TB-IGRA) positivity rate was significantly lower in the NTM-PD group. Moreover, the absolute counts of total T lymphocytes, CD4+ T lymphocytes, CD8+ T lymphocytes, NK cells, and B lymphocytes were significantly lower in patients with NTM-PD and PTB than in healthy controls. Additionally, patients with NTM-PD had a significantly lower absolute count of B lymphocytes than the PTB group. Radiological analysis revealed significant differences between patients with NTM-PD and PTB in terms of cavity wall thickness, bronchial dilation, lung consolidation, pulmonary nodule size, pulmonary emphysema, lung bullae, lymph node calcification, pleural effusion, mediastinal and hilar lymphadenopathy, and the tree-in-bud sign. Bronchial dilation was identified as the predominant risk factor of NTM-PD, whereas TB-IGRA positivity, lymph node calcification, pleural effusion, and mediastinal and hilar lymphadenopathies were protective factors. Based on this, we constructed a discriminatory diagnostic model for NTM-PD. Its receiver operating characteristic curve demonstrated good diagnostic performance, with an area under the curve of 0.938. At the maximum Youden index of 0.746, the sensitivity and specificity were 0.835 and 0.911, respectively.
CONCLUSIONS: Patients with NTM-PD and PTB exhibited impaired humoral and cellular immune functions as well as significant differences in radiological features. The constructed NTM-PD diagnostic model demonstrated good diagnostic performance. This study provides a new tool for the differential diagnosis of NTM-PD.