Department of Infectious Diseases, Centre for Health, Immunity and Infectious Diseases (CHIP), Rigshospitalet, Copenhagen, Denmark.
Section for Lung Transplantation, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Transplantation. 2018 Feb;102(2):326-332. doi: 10.1097/TP.0000000000001927.
The diagnostic yield for cytomegalovirus (CMV) polymerase chain reaction (PCR) viral load in bronchoalveolar lavage (BAL) or in plasma to diagnose CMV pneumonia in lung transplant recipients remains uncertain and was investigated in a large cohort of consecutive lung transplant recipients.
Bronchoscopies within the first year of lung transplantation with CMV detectable in BAL by PCR (ie, viral load, ≥273 IU/mL) were included (66 recipients; 145 bronchoscopies); at each bronchoscopy episode, 2 independent experts reviewed clinical and laboratory information to determine whether the patient at that time fulfilled the criteria for CMV pneumonia per current international recommendations. Corresponding plasma CMV PCR viral load determined at time of the bronchoscopy (n = 126) was also studied. Optimal CMV PCR viral load cutoff for CMV pneumonia diagnosis was determined using receiver operating characteristics.
CMV was detected in BAL with CMV PCR in 145 episodes, and 34 (23%) of these episodes fulfilled the criteria for CMV pneumonia. The area under the curve-receiver operating characteristics for CMV in BAL was 90% at the optimum cutoff (4545 IU/mL) with a corresponding sensitivity of 91% and specificity of 77% (in plasma the corresponding values were 274 IU/mL, 63% and 76%, respectively).
CMV PCR viral load in BAL had a high performance to diagnose CMV pneumonia in lung transplant recipients; plasma CMV viral load did not reliably aid as a diagnostic tool.
在肺移植受者中，支气管肺泡灌洗液（BAL）或血浆中巨细胞病毒（CMV）聚合酶链反应（PCR）病毒载量诊断 CMV 肺炎的诊断率仍不确定，本研究在一组连续的肺移植受者中对此进行了研究。
纳入肺移植后一年内 BAL 中可检测到 CMV 的 PCR（即病毒载量，≥273IU/ml）的支气管镜检查（66 例患者；145 次支气管镜检查）；在每次支气管镜检查时，2 位独立的专家审查临床和实验室信息，以确定当时的患者是否符合当前国际建议的 CMV 肺炎标准。还研究了相应的支气管镜检查时的血浆 CMV PCR 病毒载量（n=126）。使用受试者工作特征确定 CMV 肺炎诊断的最佳 CMV PCR 病毒载量临界值。
145 次支气管镜检查中检测到 BAL 中的 CMV PCR，其中 34 次（23%）符合 CMV 肺炎标准。CMV 在 BAL 中的曲线下面积-受试者工作特征的最佳临界值（4545IU/ml）为 90%，相应的敏感性为 91%，特异性为 77%（在血浆中相应值分别为 274IU/ml、63%和 76%）。
BAL 中的 CMV PCR 病毒载量对诊断肺移植受者中的 CMV 肺炎具有较高的性能；血浆 CMV 病毒载量不能作为可靠的诊断工具。
