与念珠菌病、曲霉病、毛霉病、结核病患者及健康志愿者相比，（1-3）-β-D-葡聚糖检测对耶氏肺孢子菌病患者的诊断效能。
Diagnostic performance of the (1-3)-β-D-glucan assay in patients with Pneumocystis jirovecii compared with those with candidiasis, aspergillosis, mucormycosis, and tuberculosis, and healthy volunteers.
作者信息
Son Hyo-Ju, Sung Heungsup, Park Se Yoon, Kim Taeeun, Lee Hyun Jeong, Kim Sun-Mi, Chong Yong Pil, Lee Sang-Oh, Choi Sang-Ho, Kim Yang Soo, Woo Jun Hee, Kim Sung-Han
机构信息
Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
PLoS One. 2017 Nov 30;12(11):e0188860. doi: 10.1371/journal.pone.0188860. eCollection 2017.
BACKGROUND
Diagnosis of pneumocystis pneumonia (PCP) relies on microscopic visualization of P. jirovecii, or detection of Pneumocystis DNA in respiratory specimens, which involves invasive procedures such as bronchoalveolar lavage. The (1-3)-β-D-glucan (BG) assay has been proposed as a less invasive and less expensive diagnostic test to rule out PCP. We therefore compared blood levels of BG in patients with PCP with those of patients with candidemia, chronic disseminated candidiasis (CDC), invasive aspergillosis, mucormycosis, and tuberculosis and those of healthy volunteers.
METHODS
Adult patients who were diagnosed with PCP, candidemia, CDC, invasive aspergillosis, mucormycosis, and tuberculosis whose blood samples were available, and healthy volunteers were enrolled in a tertiary hospital in Seoul, South Korea, during a 21-month period. The blood samples were assayed with the Goldstream Fungus (1-3)-β-D-glucan test (Gold Mountain River Tech Development, Beijing, China).
RESULTS
A total of 136 individuals including 50 patients P. jirovecii,15 candidemia, 6 CDC, 15 invasive aspergillosis, 10 mucormycosis, and 40 controls (20 TB and 20 healthy volunteers) were included. The mean±SD of the concentration of 1-3-β-D-glucan in the patients with PCP (290.08 pg/mL±199.98) were similar to those of patients with candidemia (314.14 pg/mL±205.60, p = 0.90 at an α = 0.005) and CDC (129.74 pg/mL±182.79, p = 0.03 at an α = 0.005), but higher than those of patients with invasive aspergillosis (131.62 pg/mL±161.67, p = 0.002 at an α = 0.005), mucormycosis (95.08 pg/mL±146.80, p<0.001 at an α = 0.005), and tuberculosis (103.31 pg/mL±140.81, p<0.001 at an α = 0.005) as well as healthy volunteers (101.18 pg/mL±197.52, p<0.001 at an α = 0.005). At a cut-off value > 31.25 pg/mL, which is highly sensitive for PCP versus tuberculosis plus healthy volunteers at the expense of specificity, the BG assay had a sensitivity of 92% (95% CI 81%-98%) and a specificity of 55% (95% CI 39%-71%).
CONCLUSIONS
The BG assay appears to be a useful adjunct test for PCP.
背景
肺孢子菌肺炎（PCP）的诊断依赖于在显微镜下观察耶氏肺孢子菌，或在呼吸道标本中检测肺孢子菌DNA，这涉及侵入性操作，如支气管肺泡灌洗。（1-3）-β-D-葡聚糖（BG）检测已被提议作为一种侵入性较小且成本较低的诊断试验，用于排除PCP。因此，我们比较了PCP患者与念珠菌血症、慢性播散性念珠菌病（CDC）、侵袭性曲霉病、毛霉病、结核病患者以及健康志愿者的血液BG水平。
方法
在韩国首尔的一家三级医院，在21个月的时间里，纳入了已诊断患有PCP、念珠菌血症、CDC、侵袭性曲霉病、毛霉病和结核病且有可用血样的成年患者，以及健康志愿者。血样采用金标法真菌（1-3）-β-D-葡聚糖检测（北京金山河科技发展公司）进行检测。
结果
共纳入136人，包括50例耶氏肺孢子菌患者、15例念珠菌血症患者、6例CDC患者、15例侵袭性曲霉病患者、10例毛霉病患者和40例对照（20例结核病患者和20例健康志愿者）。PCP患者中1-3-β-D-葡聚糖浓度的平均值±标准差（290.08 pg/mL±199.98）与念珠菌血症患者（314.14 pg/mL±205.60，在α=0.005时p=0.90）和CDC患者（129.74 pg/mL±182.79，在α=0.005时p=0.03）相似，但高于侵袭性曲霉病患者（131.62 pg/mL±161.67，在α=0.005时p=0.002）、毛霉病患者（95.08 pg/mL±146.80，在α=0.005时p<0.001）、结核病患者（103.31 pg/mL±140.81，在α=0.005时p<0.001）以及健康志愿者（101.18 pg/mL±197.52，在α=0.005时p<0.001）。在截断值>31.25 pg/mL时，BG检测对PCP与结核病加健康志愿者具有高敏感性，但以特异性为代价，其敏感性为92%（95%CI 81%-98%），特异性为55%（95%CI 39%-71%）。
结论
BG检测似乎是PCP的一种有用的辅助检测方法。
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