Esteves F, Lee C-H, de Sousa B, Badura R, Seringa M, Fernandes C, Gaspar J F, Antunes F, Matos O
Unidade de Parasitologia Médica, Grupo de Protozoários Oportunistas/VIH e Outros Protozoários, CMDT, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1349-008, Lisboa, Portugal,
Eur J Clin Microbiol Infect Dis. 2014 Jul;33(7):1173-80. doi: 10.1007/s10096-014-2054-6. Epub 2014 Feb 3.
Pneumocystis pneumonia (PcP) is a major HIV-related illness caused by Pneumocystis jirovecii. Definitive diagnosis of PcP requires microscopic detection of P. jirovecii in pulmonary specimens. The objective of this study was to evaluate the usefulness of two serum markers in the diagnosis of PcP. Serum levels of (1-3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) were investigated in 100 HIV-positive adult patients and 50 healthy blood donors. PcP cases were confirmed using indirect immunofluorescence with monoclonal anti-Pneumocystis antibodies and nested-PCR to amplify the large subunit mitochondrial rRNA gene of P. jirovecii in pulmonary specimens. BG and LDH levels in serum were measured using quantitative microplate-based assays. BG and LDH positive sera were statistically associated with PcP cases (P ≤ 0.001). Sensitivity, specificity, positive/negative predictive values (PPV/NPV), and positive/negative likelihood ratios (PLR/NLR) were 91.3 %, 61.3 %, 85.1 %, 79.2 %, 2.359, and 0.142, respectively, for the BG kit assay, and 91.3 %, 35.5 %, 75.9 %, 64.7 %, 1.415 and 0.245, respectively, for the LDH test. Serologic markers levels combined with the clinical diagnostic criteria for PcP were evaluated for their usefulness in diagnosis of PcP. The most promising cutoff levels for diagnosis of PcP were determined to be 400 pg/ml of BG and 350 U/l of LDH, which combined with clinical data presented 92.8 % sensitivity, 83.9 % specificity, 92.8 % PPV, 83.9 % NPV, 5.764 PLR and 0.086 NLR (P < 0.001). This study confirmed that BG is a reliable indicator for detecting P. jirovecii infection. The combination between BG/LDH levels and clinical data is a promising alternative approach for PcP diagnosis.
肺孢子菌肺炎(PcP)是由耶氏肺孢子菌引起的一种主要的与HIV相关的疾病。PcP的确诊需要在肺部标本中通过显微镜检测耶氏肺孢子菌。本研究的目的是评估两种血清标志物在PcP诊断中的作用。对100名HIV阳性成年患者和50名健康献血者的血清(1-3)-β-d-葡聚糖(BG)和乳酸脱氢酶(LDH)水平进行了研究。使用单克隆抗肺孢子菌抗体的间接免疫荧光法和巢式PCR扩增肺部标本中耶氏肺孢子菌的大亚基线粒体rRNA基因来确诊PcP病例。使用基于定量微孔板的检测方法测量血清中的BG和LDH水平。BG和LDH阳性血清与PcP病例在统计学上相关(P≤0.001)。对于BG试剂盒检测,敏感性、特异性、阳性/阴性预测值(PPV/NPV)和阳性/阴性似然比(PLR/NLR)分别为91.3%、61.3%、85.1%、79.2%、2.359和0.142;对于LDH检测,分别为91.3%、35.5%、75.9%、64.7%、1.415和0.245。评估了血清学标志物水平与PcP临床诊断标准相结合在PcP诊断中的作用。确定诊断PcP最有前景的临界值为BG 400 pg/ml和LDH 350 U/l,结合临床数据时敏感性为92.8%、特异性为83.9%、PPV为92.8%、NPV为83.9%、PLR为5.764、NLR为0.086(P<0.001)。本研究证实BG是检测耶氏肺孢子菌感染的可靠指标。BG/LDH水平与临床数据相结合是一种有前景的PcP诊断替代方法。
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