Wills Nicola K, Adriaanse Marguerite, Erasmus Shandri, Wasserman Sean
Department of Medicine, University of Cape Town, Cape Town, South Africa.
Victoria Hospital Wynberg, Cape Town, South Africa.
Open Forum Infect Dis. 2024 Mar 18;11(4):ofae146. doi: 10.1093/ofid/ofae146. eCollection 2024 Apr.
The performance of chest x-ray (CXR) features for pneumonia (PCP) diagnosis has been evaluated in small studies. We conducted a systematic review and meta-analysis to describe CXR changes in adults with HIV-associated laboratory-confirmed PCP, comparing these with non-PCP respiratory disease.
We searched databases for studies reporting CXR changes in people >15 years old with HIV and laboratory-confirmed PCP and those with non-PCP respiratory disease. CXR features were grouped using consensus terms. Proportions were pooled and odds ratios (ORs) generated using random-effects meta-analysis, with subgroup analyses by CD4 count, study period, radiology review method, and study region.
Fifty-one studies (with 1821 PCP and 1052 non-PCP cases) were included. Interstitial infiltrate (59%; 95% CI, 52%-66%; 36 studies, n = 1380; = 85%) and ground-glass opacification (48%; 95% CI, 15%-83%; 4 studies, n = 57; = 86%) were common in PCP. Cystic lesions, central lymphadenopathy, and pneumothorax were infrequent. Pleural effusion was rare in PCP (0%; 95% CI, 0%-2%). Interstitial infiltrate (OR, 2.3; 95% CI, 1.4-3.9; = 60%), interstitial-alveolar infiltrate (OR, 10.2; 95% CI, 3.2-32.4; = 0%), and diffuse CXR changes (OR, 7.3; 95% CI, 2.7-20.2; = 87%) were associated with PCP diagnosis. There was loss of association with alveolar infiltrate in African studies.
Diffuse CXR changes and interstitial-alveolar infiltrates indicate a higher likelihood of PCP. Pleural effusion, lymphadenopathy, and focal alveolar infiltrates suggest alternative causes. These findings could be incorporated into clinical algorithms to improve diagnosis of HIV-associated PCP.
在小型研究中已对胸部X线（CXR）特征在肺炎（PCP）诊断中的表现进行了评估。我们进行了一项系统评价和荟萃分析，以描述成人HIV相关实验室确诊PCP患者的CXR变化，并将其与非PCP呼吸系统疾病进行比较。
我们在数据库中搜索报告15岁以上HIV患者以及实验室确诊PCP患者和非PCP呼吸系统疾病患者CXR变化的研究。使用共识术语对CXR特征进行分组。采用随机效应荟萃分析汇总比例并生成比值比（OR），并按CD4细胞计数、研究时期、放射学审查方法和研究地区进行亚组分析。
纳入了51项研究（1821例PCP患者和1052例非PCP患者）。间质浸润（59%；95%CI，52%-66%；36项研究，n = 1380；I² = 85%）和磨玻璃样混浊（48%；95%CI，15%-83%；4项研究，n = 57；I² = 86%）在PCP中常见。囊性病变、中央淋巴结肿大和气胸不常见。胸腔积液在PCP中罕见（0%；95%CI，0%-2%）。间质浸润（OR，2.3；95%CI，1.4-3.9；I² = 60%）、间质-肺泡浸润（OR，10.2；95%CI，3.2-32.4；I² = 0%）和弥漫性CXR改变（OR，7.3；95%CI，2.7-20.2；I² = 87%）与PCP诊断相关。在非洲的研究中，肺泡浸润与PCP诊断的相关性消失。
弥漫性CXR改变和间质-肺泡浸润提示PCP的可能性较高。胸腔积液、淋巴结肿大和局灶性肺泡浸润提示其他病因。这些发现可纳入临床算法，以改善HIV相关PCP的诊断。
