Cruciani M, Marcati P, Malena M, Bosco O, Serpelloni G, Mengoli C
Center of Preventive Medicine HIV Outpatient Clinic, Verona, Italy.
Eur Respir J. 2002 Oct;20(4):982-9. doi: 10.1183/09031936.02.01372002.
Sputum induction is a simple and noninvasive procedure for Pneumocystis carinii pneumonia (PCP) diagnosis in human immunodeficiency virus-1-positive patients, although less sensitive than bronchoalveolar lavage (BAL). In order to obtain an overview of the diagnostic accuracy of sputum induction, a systematic review and meta-analysis of studies reporting the comparative sensitivity and specificity of BAL (the "gold standard") and sputum induction was performed. The odds ratio and related 95% confidence interval were calculated using summary receiving operating characteristic curves as well as fixed-effect and random-effect models. Based on pooled data, the negative and positive predictive values were calculated for a range of PCP prevalence using a Bayesian approach. Seven prospective studies assessed the comparative accuracy of BAL and sputum induction. On the whole, sputum induction demonstrated 55.5% sensitivity and 98.6% specificity. The sensitivity of sputum induction was significantly higher with immunofluorescence than with cytochemical staining (67.1 versus 43.1%). In settings of 25-60% prevalence of PCP, the positive and negative predictive values ranged 86-96.7 and 66.2-89.8, respectively, with immunofluorescence, and 79-94.4 and 53-83.5% with cytochemical staining. In conclusion, in a setting of low prevalence of Pneumocystis carinii pneumonia, sputum induction, particularly with immunostaining, appears to be adequate for clinical decision-making.
痰液诱导是一种用于诊断人类免疫缺陷病毒1型阳性患者卡氏肺孢子虫肺炎（PCP）的简单且非侵入性的方法，尽管其敏感性低于支气管肺泡灌洗（BAL）。为了全面了解痰液诱导的诊断准确性，我们对报告BAL（“金标准”）和痰液诱导的比较敏感性和特异性的研究进行了系统评价和荟萃分析。使用汇总接受操作特征曲线以及固定效应和随机效应模型计算比值比和相关的95%置信区间。基于汇总数据，采用贝叶斯方法计算了一系列PCP患病率的阴性和阳性预测值。七项前瞻性研究评估了BAL和痰液诱导的比较准确性。总体而言，痰液诱导的敏感性为55.5%，特异性为98.6%。免疫荧光法检测痰液诱导的敏感性显著高于细胞化学染色法（67.1%对43.1%）。在PCP患病率为25%-60%的情况下，免疫荧光法的阳性和阴性预测值分别为86%-96.7%和66.2%-89.8%，细胞化学染色法的阳性和阴性预测值分别为79%-94.4%和53%-83.5%。总之，在卡氏肺孢子虫肺炎患病率较低的情况下，痰液诱导，尤其是免疫染色法，似乎足以用于临床决策。
