摘要目的:探讨单核细胞/淋巴细胞比值(MLR)对耐多药肺结核(MDR-TB)病情严重程度是否有预测价值。方法:本研究为队列研究。采用非随机抽样法选取2020年1月至2022年5月南京市第二医院结核科住院确诊的MDR-TB患者204例，使用Bandim TBscore评分法将MDR-TB患者分为轻度( n＝151例)组和中-重度( n＝53例)组。单因素分析比较2组患者临床基线资料，多因素logistic分析评估中-重度耐药结核危险因素。采用受试者工作特征(ROC)曲线评估MLR对MDR-TB病情严重程度的预测价值。 结果:MDR-TB患者中-重度组MLR值显著高于轻度组0.99(0.71，2.02)比0.38(0.26，0.52)，差异有统计学意义( Z＝7.86， P<0.001)。MLR是MDR-TB病情严重程度的预测因子( OR＝3.62，95% CI：1.49~3.90， P＝0.017)。MLR与TBscore呈正相关，在ROC曲线分析中，MLR对中-重度MDR-TB有较好的预测价值，曲线下面积为0.86，最佳截断值为0.65，预测MDR-TB病情严重的敏感度为81.1%，特异度为83.4%(95% CI：0.80~0.93， P<0.001)。 结论:MLR升高与MDR-TB严重程度密切相关，可作为MDR-TB病情严重的预测因子。

abstractsObjective:To investigate the predictive value of monocyte/lymphocyte ratio (MLR) in the severity of multidrug-resistant tuberculosis (MDR-TB).Methods:This was a cohort study.Non-random sampling method was adopted to select 204 cases of MDR-TB confirmed in the Tuberculosis Department of Nanjing Second Hospital from January 2020 to May 2022.The MDR-TB patients were divided into mild ( n=151) and moderate-severe ( n=53) groups using Bandim TBscore.Univariate analysis was used to compare the clinical baseline data of the two groups, and multivariate logistic analysis was used to evaluate the risk factors of moderate-severe drug-resistant tuberculosis.The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of MLR on the severity of MDR-TB. Results:The MLR value of the moderate-severe group was significantly higher than that of the mild group by 0.99(0.71, 2.02) vs 0.38(0.26, 0.52), with statistical significance ( Z=7.86, P<0.001). MLR was a predictor of the severity of MDR-TB ( OR=3.62, 95% CI: 1.49-3.90, P=0.017), and had a significantly positive correlation with TBscore.In ROC curve analysis, MLR had a good predictive value for moderate-severe MDR-TB.The area under the curve was 0.86, and the cut-off value was 0.65.The sensitivity and specificity of MLR for predicting severe MDR-TB were 81.1% and 83.4% respectively (95% CI: 0.80-0.93, P<0.001). Conclusions:The elevation of MLR is closely related with the severity of MDR-TB and thus MLR can be used as a predictor for the severity of MDR-TB.