Leigh T R, Kangro H O, Gazzard B G, Jeffries D J, Collins J V
Department of Respiratory Medicine, Westminster Hospital, London, U.K.
Respir Med. 1993 Oct;87(7):525-9. doi: 10.1016/0954-6111(93)90008-n.
Pneumocystis carinii colonization was studied in 90 men using the polymerase chain reaction. These comprised ten heterosexual controls; ten HIV-seronegative homosexual controls; 20 HIV-seropositive homosexuals with blood CD4 count > 400 x 10(6) l-1; 20 HIV-seropositive homosexuals with CD4 < 400 x 10(6) l-1; ten HIV-seropositive homosexuals with CD4 < 60 x 10(6) l-1 receiving PCP chemoprophylaxis; and 20 HIV-seropositive homosexuals with respiratory symptoms but without PCP. Induced sputum was obtained from all but the last group, who had bronchoalveolar lavage, and all specimens were tested for P. carinii using the polymerase chain reaction. The first four groups received no pneumocystis chemoprophylaxis, and all but the last group were asymptomatic. P. carinii colonization did not occur in the two control groups. P. carinii colonization rates were significantly different in the CD4 > 400, CD4 < 400, and CD4 < 60 groups (10%, 20%, and 40% respectively) (P < 0.025). Two patients (one each from CD4 < 400 and CD4 < 60) developed PCP 4-6 weeks after sputum induction, both had previously had high levels of P. carinii on sputum induction. Two patients from the CD4 < 400 group had high levels of P. carinii but did not develop PCP. In the symptomatic group, two subjects had low levels of P. carinii, but did not develop PCP. We have demonstrated P. carinii colonization in HIV-seropositive homosexuals in association with a low peripheral CD4 count. The polymerase chain reaction may be a useful technique for determining the need and efficacy of anti-pneumocystis chemoprophylaxis.
采用聚合酶链反应对90名男性进行卡氏肺孢子虫定植情况的研究。其中包括10名异性恋对照者；10名HIV血清学阴性的同性恋对照者；20名血液CD4计数>400×10⁶/L⁻¹的HIV血清学阳性同性恋者；20名CD4<400×10⁶/L⁻¹的HIV血清学阳性同性恋者；10名接受卡氏肺孢子虫肺炎（PCP）化学预防的CD4<60×10⁶/L⁻¹的HIV血清学阳性同性恋者；以及20名有呼吸道症状但未患PCP的HIV血清学阳性同性恋者。除最后一组通过支气管肺泡灌洗获取样本外，其余组均通过诱导痰获取样本，所有样本均采用聚合酶链反应检测卡氏肺孢子虫。前四组未接受抗肺孢子虫化学预防，除最后一组外均无症状。两个对照组未出现卡氏肺孢子虫定植。CD4>400、CD4<400和CD4<60组的卡氏肺孢子虫定植率有显著差异（分别为10%、20%和40%）（P<0.025）。两名患者（分别来自CD4<400组和CD4<60组）在诱导痰后4 - 6周发生PCP，两人诱导痰时卡氏肺孢子虫水平均较高。CD4<400组的两名患者卡氏肺孢子虫水平较高，但未发生PCP。有症状组中，两名受试者卡氏肺孢子虫水平较低，但未发生PCP。我们已证实在外周血CD4计数较低的HIV血清学阳性同性恋者中存在卡氏肺孢子虫定植。聚合酶链反应可能是一种用于确定抗肺孢子虫化学预防的必要性和疗效的有用技术。
