Diagnosis of Pneumocystis jirovecii pneumonia with serum cell-free DNA in non-HIV-infected immunocompromised patients.
Diagnosis of Pneumocystis jirovecii pneumonia with serum cell-free DNA in non-HIV-infected immunocompromised patients.
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非 HIV 感染免疫功能低下患者血清游离 DNA 诊断耶氏肺孢子菌肺炎
DOI：
10.18632/oncotarget.18037
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发表时间：
2017-09-22
期刊：
影响因子：
--
通讯作者：
Tong ZH
中科院分区：
文献类型：
--
作者：
Wang D;Hu Y;Li T;Rong HM;Tong ZH
常规呼吸道标本，如支气管肺泡灌洗液和诱导痰，难以获得诊断免疫功能低下患者的肺囊虫肺炎（PCP）。此外，支气管镜检查是一种侵入性手术，有引起快速进行性呼吸功能不全的风险。相比之下，血清无细胞DNA （cfDNA）很容易获得，并已被证明在诊断癌症、妊娠相关并发症、寄生虫感染和败血症方面很有用。在这项研究中，我们采用定量聚合酶链反应（qPCR）来评估使用血清cfDNA、BAL液和痰DNA对PCP的诊断效率。根据临床PCP诊断标准纳入71例患者（35例PCP患者和36例非PCP患者）。血清cfDNA PCR的敏感性、特异性、阳性预测值和阴性预测值分别为68.6% （95% CI, 50.7 ~ 83.1）、97.2% （95% CI, 85.5 ~ 99.9）、96.0%和76.1%。用BAL液和痰进行PCR检测灵敏度高（分别为97.1%和91.4%），但特异性较低（分别为86.1%和86.1%）。痰液PCR或血清cfDNA PCR联合检测的灵敏度为97.1%。提示血清cfDNA可能是诊断PCP的一种有价值的方法。
Conventional respiratory tract specimens, such as bronchoalveolar lavage (BAL) fluid and induced sputum for diagnosing Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients are difficult to obtain. Besides, bronchoscopy is an invasive procedure that carries the risk of causing rapidly progressive respiratory insufficiency. By contrast, serum cell-free DNA (cfDNA) is easy to obtain and has been proven useful in diagnosing cancer, pregnancy associated complications, parasite infection and sepsis. In this study, we performed quantitative polymerase chain reaction (qPCR) to assess the diagnostic efficiency of using serum cfDNA, BAL fluid, and sputum DNA for PCP. Seventy-one patients (35 PCP patients and 36 non-PCP patients) were enrolled according to the clinical PCP diagnostic criteria. The sensitivity, specificity, positive predictive value, and negative predictive value of PCR using serum cfDNA were 68.6% (95% CI, 50.7–83.1), 97.2% (95% CI, 85.5–99.9), 96.0%, and 76.1%, respectively. PCR using BAL fluid and sputum had a high sensitivity (97.1% and 91.4%, respectively) but relatively low specificity (86.1% and 86.1%, respectively). The combination of the sputum PCR OR serum cfDNA PCR yielded a sensitivity of 97.1%.These results indicated that serum cfDNA might be a valuable method in PCP diagnosis.
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