Unidade de Parasitologia Médica, Grupo de Protozoários Oportunistas/VIH e Outras Protozooses-CMDT, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
Unidade de Parasitologia Médica, Grupo de Protozoários Oportunistas/VIH e Outras Protozooses-CMDT, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
Clin Microbiol Infect. 2015 Apr;21(4):379.e1-10. doi: 10.1016/j.cmi.2014.11.025. Epub 2014 Dec 4.
The diagnosis of Pneumocystis pneumonia (PCP) relies on microscopic visualization of Pneumocystis jirovecii organisms or DNA detection in pulmonary specimens. This study aimed to assess the usefulness of (1-3)-β-d-glucan (BG), Krebs von den Lungen-6 antigen (KL-6), lactate dehydrogenase (LDH) and S-adenosyl methionine (SAM) as serologic biomarkers in the diagnosis of PCP. Serum levels of BG, KL-6, LDH and SAM were investigated in 145 Portuguese patients, 50 patients from the Netherlands, 25 Spanish patients and 40 Portuguese blood donors. Data on clinical presentation, chest imaging and gasometry tests were available. PCP cases were confirmed by microscopy and PCR techniques. A cost-effectiveness analysis was performed. BG was found to be the most reliable serologic biomarker for PCP diagnosis, followed by KL-6, LDH and SAM. The BG/KL-6 combination test was the most accurate serologic approach for PCP diagnosis, with 94.3% sensitivity and 89.6% specificity. Although less sensitive/specific than the reference standard classic methods based on bronchoalveolar lavage followed by microscopic or molecular detection of P. jirovecii organisms, the BG/KL-6 test may provide a less onerous procedure for PCP diagnosis, as it uses a minimally invasive and inexpensive specimen (blood), which may be also a major benefit for the patient's care. The BG/KL-6 combination test should be interpreted within the clinical context, and it may be used as a preliminary screening test in patients with primary suspicion of PCP, or as an alternative diagnostic procedure in patients with respiratory failure or in children, avoiding the associated risk of complications by the use of bronchoscopy.
卡氏肺孢子虫肺炎（PCP）的诊断依赖于卡氏肺孢子虫（Pneumocystis jirovecii）生物体的显微镜可视化或肺标本中的 DNA 检测。本研究旨在评估（1-3）-β-D-葡聚糖（BG）、KL-6 抗原（KL-6）、乳酸脱氢酶（LDH）和 S-腺苷甲硫氨酸（SAM）作为血清学生物标志物在 PCP 诊断中的有用性。研究人员调查了 145 名葡萄牙患者、50 名荷兰患者、25 名西班牙患者和 40 名葡萄牙献血者的血清 BG、KL-6、LDH 和 SAM 水平。研究人员获得了有关临床表现、胸部影像学和气体分析测试的数据。PCP 病例通过显微镜和 PCR 技术确认。进行了成本效益分析。结果显示，BG 是诊断 PCP 最可靠的血清学生物标志物，其次是 KL-6、LDH 和 SAM。BG/KL-6 联合检测是诊断 PCP 最准确的血清学方法，具有 94.3%的敏感性和 89.6%的特异性。尽管比基于支气管肺泡灌洗后显微镜或分子检测卡氏肺孢子虫生物体的经典方法的参考标准敏感性/特异性低，但 BG/KL-6 试验可能为 PCP 诊断提供一种不那么繁琐的程序，因为它使用了一种微创且廉价的标本（血液），这对患者的护理也可能是一个主要的好处。BG/KL-6 联合检测应结合临床情况进行解释，它可作为疑似 PCP 患者的初步筛查试验，或在呼吸衰竭或儿童患者中作为替代诊断程序，避免使用支气管镜检查相关的并发症风险。
