del Rio C, Guarner J, Honig E G, Slade B A
Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Arch Pathol Lab Med. 1988 Dec;112(12):1229-32.
To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS), we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum, 15.3%; negative predictive value, 60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS, but, because of the test's low sensitivity, it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.
为研究痰检在获得性免疫缺陷综合征（AIDS）患者卡氏肺孢子虫肺炎诊断中的作用，我们对30例AIDS患者或疑似AIDS患者进行了一项前瞻性研究。在支气管镜检查前，通过自主咳嗽（20例患者）或盐水雾化诱导（10例患者）获取痰液。30例患者中有13例通过支气管肺泡灌洗诊断为卡氏肺孢子虫肺炎；其中2例患者的痰液标本中发现了卡氏肺孢子虫（痰检敏感性为15.3%；阴性预测值为60.7%）。一项成本分析研究表明，当敏感性低于24%时，痰检不具有成本效益。我们得出结论，AIDS患者可通过咳出的痰液诊断卡氏肺孢子虫，但由于该检测敏感性较低，在对有肺部症状的AIDS患者进行常规评估时不推荐使用。
