Shafiek Hanaa, Fiorentino Federico, Cosio Borja G, Kersul Ana, Thiberville Luc, Gómez Cristina, Riera Melchor, Martín Maria L, Martínez Rocio, Noguera Maria A, Agustí Alvar, Sauleda Jaume
Servei Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
Respiration. 2016;92(1):40-7. doi: 10.1159/000447431. Epub 2016 Jul 1.
Probe-based confocal laser endomicroscopy (pCLE) is a novel technique that provides in vivo microscopic imaging of the distal lung. We hypothesized that the intra-alveolar exudates characterizing Pneumocystis jirovecii pneumonia (PJP) can be identified by pCLE in vivo and help in its diagnosis.
We aimed to assess the usefulness of pCLE for the in vivo diagnosis of PJP.
Thirty-two human immunodeficiency virus (HIV)-positive patients with new pulmonary infiltrates and fever were studied using pCLE. Real-time alveolar images were recorded during the bronchoscopy for off-line analysis by two independent observers. Bronchoalveolar lavage samples were also obtained and processed for microbiology and cytological evaluation, including Grocott stain for P. jirovecii. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of pCLE for the diagnosis of PJP in these patients were calculated.
Fourteen patients (44%) were confirmed to have PJP by cultures/staining. pCLE was well tolerated in all patients. It identified intra-alveolar exudates in 13 of them (41%), where 11 of them (85%) had positive Grocott stain for P. jirovecci, with 93% concordance between observers. Sensitivity, specificity, PPV and NPV of pCLE for the diagnosis of PJP were 79, 89, 85 and 84%, respectively. In smokers, these figures improved to be 92, 88, 85 and 94%.
pCLE is a quick and safe procedure for on-site diagnosis of PJP in HIV+ patients with excellent specificity and sensitivity mainly in smokers.
基于探头的共聚焦激光内镜显微镜检查（pCLE）是一种可为肺远端提供体内微观成像的新技术。我们推测，卡氏肺孢子菌肺炎（PJP）特征性的肺泡内渗出物可通过pCLE在体内识别，有助于其诊断。
我们旨在评估pCLE对PJP进行体内诊断的实用性。
对32例有新发肺部浸润和发热的人类免疫缺陷病毒（HIV）阳性患者使用pCLE进行研究。在支气管镜检查期间记录实时肺泡图像，以供两名独立观察者进行离线分析。还获取支气管肺泡灌洗样本并进行微生物学和细胞学评估，包括卡氏肺孢子菌的Grocott染色。计算pCLE对这些患者诊断PJP的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
14例患者（44%）经培养/染色确诊为PJP。所有患者对pCLE耐受性良好。其中13例（41%）通过pCLE识别出肺泡内渗出物，其中11例（85%）卡氏肺孢子菌Grocott染色呈阳性，观察者之间的一致性为93%。pCLE诊断PJP的敏感性、特异性、PPV和NPV分别为79%、89%、85%和84%。在吸烟者中，这些数值分别提高到92%、88%、85%和94%。
pCLE是一种快速、安全的方法，可用于现场诊断HIV阳性患者的PJP，主要在吸烟者中具有出色的特异性和敏感性。
