Distinguishing lung cancer from pulmonary infection and interstitial lung disease (ILD) remains challenging. This study aimed to evaluate the diagnostic value of T lymphocyte subsets and neutrophil CD64 (nCD64) index in bronchoalveolar lavage fluid (BALF), alone and in combination, to address this challenge. BALF was collected between October 2021 and October 2022 from 70 patients admitted to West China Hospital, Sichuan University. Based on final diagnosis, the patients were divided into the lung cancer group (21 cases, including 14 with pure lung cancer and 7 with lung cancer and infection) and the non‑lung cancer group (49 cases, including 39 with pulmonary infection and 10 with ILD). Flow cytometry was used to detect T lymphocyte subsets and CD64 expression in BALF, and the CD4+/CD8+ ratio and nCD64 index were calculated. Receiver operating characteristic (ROC) curves were used to evaluate the performance of both indicators in differentiating lung cancer from pulmonary infection and from ILD, and the area under the curve (AUC) and 95% confidence interval (CI) were calculated. The diagnostic efficacy of combining the CD4+/CD8+ ratio and nCD64 index for differentiating lung cancer from pulmonary infection was further analyzed. Firth's logistic regression was performed to adjust for age and to assess the independent differential diagnosis value of the two indicators between lung cancer and pulmonary infection. Compared with the non-lung cancer group, the lung cancer group showed significantly lower CD4+ T cell proportion, CD4+/CD8+ ratio, and nCD64 index (all P<0.05). Further analysis revealed that the lung cancer group also had significantly lower values of the above indicators compared with the pulmonary infection group (P<0.05), but no significant differences were observed compared with the ILD group (P>0.05). ROC curve analysis showed that the CD4+/CD8+ ratio had an AUC of 0.712 (95%CI: 0.575‑0.849, P=0.008) for differentiating lung cancer from pulmonary infection, with a sensitivity of 56.76% and a specificity of 85.00%; the nCD64 index had an AUC of 0.677 (95%CI: 0.539‑0.814, P=0.026), with a sensitivity of 44.74% and a specificity of 95.24%. When the two indicators were combined, the parallel test increased the sensitivity to 78.38%, while the serial test achieved 100.00% specificity and positive predictive value. After adjusting for age, Firth's logistic regression demonstrated that both the CD4+/CD8+ ratio and nCD64 index retained independent differential diagnosis value for differentiating lung cancer from pulmonary infection (both P<0.05). The combined detection of the CD4+/CD8+ ratio and nCD64 index in BALF improves the diagnostic efficacy for differentiating lung cancer from pulmonary infection. 【中文题目：支气管肺泡灌洗液CD4+/CD8+联合
nCD64指数对肺癌与非肺癌疾病的鉴别诊断价值】 【中文摘要：背景与目的 肺癌与肺感染性疾病、间质性肺疾病（interstitial lung disease, ILD）的临床鉴别尚存在困难，本研究旨在探讨支气管肺泡灌洗液（bronchoalveolar lavage fluid, BALF）中T淋巴细胞亚群及中性粒细胞CD64（neutrophil CD64, nCD64）指数单独及联合检测在上述疾病中的鉴别诊断价值。方法 收集2021年10月至2022年10月于四川大学华西医院就诊的70例患者BALF标本，根据诊断分为肺癌组（21例，含单纯肺癌14例、肺癌合并感染7例）和非肺癌组（49例，含肺感染性疾病39例、ILD 10例）。采用流式细胞术检测BALF中T淋巴细胞亚群及CD64表达，计算CD4+/CD8+比值及nCD64指数。采用受试者工作特征（receiver operating characteristic, ROC）曲线评估各指标鉴别肺癌与肺感染性疾病、肺癌与ILD的价值，计算曲线下面积（area under the curve, AUC）及其95%置信区间（confidence interval, CI），并分析CD4+/CD8+比值及nCD64指数联合对肺癌与肺感染性疾病的鉴别诊断效能。采用Firth's logistic回归进行多因素分析，探讨两指标对肺癌与肺感染的独立鉴别价值。结果 与非肺癌组相比，肺癌组CD4+ T细胞比例、CD4+/CD8+比值及nCD64指数均显著降低（均P<0.05）。进一步分析发现，与肺感染性疾病组相比，肺癌组上述指标亦显著下降（P<0.05），但与ILD组相比无显著差异（P>0.05）。ROC曲线显示，CD4+/CD8+比值鉴别肺癌和肺感染性疾病的AUC为0.712（95%CI: 0.575-0.849, P=0.008），灵敏度为56.76%，特异度为85.00%；nCD64指数鉴别肺癌与肺感染性疾病的AUC为0.677（95%CI: 0.539-0.814, P=0.026），灵敏度为44.74%，特异度为95.24%。联合应用CD4+/CD8+比值及nCD64指数时，并联试验的灵敏度提升至78.38%，串联试验的特异度及阳性预测值均达100.00%。校正年龄后，Firth's logistic回归显示CD4+/CD8+比值和nCD64指数仍对肺癌与肺感染性疾病的鉴别具有独立价值（均P<0.05）。结论 BALF中CD4+/CD8+比值与nCD64指数联合检测可提高肺癌与肺感染性疾病的鉴别诊断效能。
】 【中文关键词：支气管肺泡灌洗液；T淋巴细胞亚群；CD4+/CD8+比值；nCD64指数；肺肿瘤；肺感染性疾病；鉴别诊断】.
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arXiv · 2025-02-24
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