Woods G L, Thompson A B, Rennard S L, Linder J
Department of Pathology, University of Nebraska Medical Center, Omaha 68198.
Chest. 1990 Sep;98(3):568-75. doi: 10.1378/chest.98.3.568.
To diagnose cytomegalovirus pneumonia in a hetergeneous population of patients, three methods for detection of CMV in bronchoalveolar lavage specimens were compared as follow: (1) spin amplification followed by staining with a monoclonal antibody to the early nuclear antigen (EA-assay); (2) conventional tissue cell culture; and (3) cytology. Cell differentials were performed on most specimens. Cytomegalovirus was detected by one or more method in 55 BAL specimens from 39 patients. Cytomegalovirus (CMV) pneumonia was diagnosed by lung tissue (primarily autopsy) histologic findings and conventional culture results or the presence of CMV in extrapulmonary tissue, fulfillment of specific clinical and radiographic criteria plus failure to recover a pathogen other than CMV from a respiratory specimen. Probable CMV pneumonia was diagnosed if only the latter two criteria were met. The EA-assay was positive in all patients with proven or probable CMV pneumonia and in 92 percent of those without documented pneumonia. Cytologic findings were positive only in patients with CMV pneumonia but were negative in one-third of those patients. As a diagnostic test for CMV pneumonia, the EA-assay, conventional culture, and cytology had positive predictive values of 45, 57, and 100 percent, respectively. Lymphocyte percentages in BAL specimens from patients with CMV pneumonia were significantly decreased compared with those of patients without CMV pneumonia (p less than 0.005). Although the EA-assay should not be used alone as a diagnostic test for CMV pneumonia in our patient population, the combination of alveolar lymphopenia and a positive BAL CMV EA-assay was highly suggestive of disease.
为了在异质性患者群体中诊断巨细胞病毒肺炎，对支气管肺泡灌洗标本中检测巨细胞病毒的三种方法进行了如下比较：（1）旋转扩增后用针对早期核抗原的单克隆抗体染色（EA检测）；（2）传统组织细胞培养；（3）细胞学检查。对大多数标本进行了细胞分类。在来自39例患者的55份支气管肺泡灌洗标本中，通过一种或多种方法检测到了巨细胞病毒。根据肺组织（主要是尸检）的组织学发现、传统培养结果或肺外组织中巨细胞病毒的存在、满足特定的临床和影像学标准以及未能从呼吸道标本中分离出除巨细胞病毒以外的病原体来诊断巨细胞病毒（CMV）肺炎。如果仅满足后两个标准，则诊断为可能的CMV肺炎。在所有确诊或可能患有CMV肺炎的患者以及92%没有记录肺炎的患者中，EA检测呈阳性。细胞学检查结果仅在CMV肺炎患者中呈阳性，但在三分之一的此类患者中呈阴性。作为CMV肺炎的诊断试验，EA检测、传统培养和细胞学检查的阳性预测值分别为45%、57%和100%。与没有CMV肺炎的患者相比，CMV肺炎患者支气管肺泡灌洗标本中的淋巴细胞百分比显著降低（p<0.005）。虽然在我们的患者群体中，EA检测不应单独用作CMV肺炎的诊断试验，但肺泡淋巴细胞减少和支气管肺泡灌洗CMV EA检测呈阳性相结合高度提示患有该病。
