血小板淋巴细胞比与尿酸用于脊柱结核与布鲁氏菌性脊柱炎早期诊断价值研究OA

Background The elderly population has a relatively high proportion in spinal tuberculosis(STB)and brucellosis spondylitis(BS),especially in those with underlying diseases and low income.Traditional methods are inadequate for early differentiation between the two diseases.Serological tests and PCR are costly,while bacterial culture is time-consuming.Therefore,exploring laboratory diagnostic indicators for these two diseases under the influence of underlying diseases holds important clinical significance.Objective To investigate the value of common laboratory indicators[platelet-to-lymphocyte ratio(PLR)and uric acid(UA)]in distinguishing STB from BS.Methods A total of 232 patients diagnosed with STB and BS at the Second Affiliated Hospital of Inner Mongolia Medical University from January 1,2015 to October 31,2024 were included in this study.Patients were divided into STB group(132 cases)and BS group(100 cases),and further categorized into groups with and without underlying diseases(132 cases without underlying diseases and 100 cases with underlying diseases).Laboratory indicators,including complete blood count,biochemical parameters,and inflammatory markers,were collected and compared between groups.Multivariate Logistic regression analysis was conducted to identify clinically meaningful predictive markers and construct a predictive model.The model fit was evaluated via Hosmer-Lemeshow goodness-of-fit test.The sensitivity and specificity of the model were evaluated using the receiver operating characteristic(ROC)curve,and the area under the curve(AUC)was used to assess its predictive value.The differences in AUC values among the ROC curves of various indicators were compared via DeLong test.Results Multivariate Logistic regression analysis revealed that PLR(OR=0.993,95%CI=0.990-0.997)and UA(OR=0.994,95%CI=0.991-0.997)were independent influencing factors in distinguishing STB from BS(P<0.05).The Hosmer-Lemeshow test results indicated that the model fit was good(χ2=3.721,P=0.881).The AUC for diagnosing STB and BS using PLR was 0.649,with an optimal cutoff value of 162.14,sensitivity of 59.1%and specificity of 64.0%.The AUC for diagnosing STB and BS using UA was 0.669,with an optimal cutoff value of 383.75 μmol/L,sensitivity of 34.8%,and specificity of 93.0%.The AUC for diagnosing STB and BS using the combination of PLR and UA was 0.721,with an optimal probability cutoff value of 0.489,sensitivity of 69.7%and specificity of 66.0%.Result of Delong test showed that the AUC value of the combined diagnosis of PLR and UA was higher than that of PLR alone,with a statistically significant difference(Z=2.167,P=0.030).However,the difference between the combined diagnosis and UA alone was not statistically significant(Z=1.884,P=0.065).Conclusion PLR and UA can serve as reference indicators for the early-stage differential diagnosis between STB and BS.The combined diagnostic efficacy of the two biomarkers outperforms standalone PLR.They are applicable to early screening and differentiation among elderly patients and possess prominent clinical application value.