Serum markers in interstitial pneumonia with and without Pneumocystis jirovecii colonization: a prospective study
Serum markers in interstitial pneumonia with and without Pneumocystis jirovecii colonization: a prospective study
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有或没有耶氏肺孢子虫定植的间质性肺炎的血清标志物：一项前瞻性研究
作者：
Y. Shimizu;N. Sunaga;K. Dobashi;M. Fueki;N. Fueki;S. Makino;M. Mori
在慢性呼吸系统疾病患者中，可观察到耶氏肺孢子虫（P. jirovecii）定植，并可能影响疾病进展和全身炎症。肺孢子虫肺炎引起间质性改变，因此诊断患有间质性肺炎（IP）并伴耶氏肺孢子虫定植的患者中的PCP有时很难基于放射学检查。方法本研究调查了IP患者中耶氏肺孢子虫定植的患病率，并通过测量血清标志物评估耶氏肺孢子虫定植引起的肺损伤（KL-6、SP-A、SP-D和（1→3）β-D-葡聚糖（β-D-葡聚糖））和外周淋巴细胞计数。本前瞻性研究共入组了75例特发性肺纤维化（n = 29）、胶原血管相关性间质性肺炎（n = 19）、慢性支气管炎或肺炎（n = 20）和肺孢子虫肺炎（n = 7）患者。在痰液样本中检测到P. jirovecii DNA，而血清标志物和外周血淋巴细胞计数进行了测量。ResultsIP患者（特发性肺纤维化和胶原血管相关IP）谁接受口服皮质类固醇激素的P. jirovecii定植（23.3%）的患病率很高。在IP患者中，口服糖皮质激素治疗是耶氏疟原虫定植的显著危险因素（P < 0.05）。血清标志物未显示IP患者与无P. jirovecii定植之间的差异。结论血清KL-6、SP-A、SP-D和β-D-葡聚糖水平不能作为诊断IP患者肺孢子虫定植的指标。而血清β-D-葡聚糖水平和淋巴细胞计数有助于区分IP患者中的耶氏肺孢子虫定植和肺孢子虫肺炎。
BackgroundIn patients with chronic respiratory disease, Pneumocystis jirovecii (P. jirovecii) colonization is observed, and may influence disease progression and systemic inflammation. Pneumocystis pneumonia causes interstitial changes, so making a diagnosis of PCP in patients who have interstitial pneumonia (IP) with P. jirovecii colonization is sometimes difficult based on radiography.MethodsThis study investigated the prevalence of P. jirovecii colonization in IP patients and assessed pulmonary injury due to P. jirovecii colonization by measurement of serum markers (KL-6, SP-A, SP-D, and (1→3) β-D-glucan (β-D-glucan)) and the peripheral lymphocyte counts, prospectively. A total of 75 patients with idiopathic pulmonary fibrosis (n = 29), collagen vascular-related interstitial pneumonia (n = 19), chronic bronchitis or pneumonia (n = 20), and Pneumocystis pneumonia (n = 7) were enrolled in this prospective study. P. jirovecii DNA was detected in sputum samples, while serum markers and the lymphocyte count were measured in the peripheral blood.ResultsIP patients (idiopathic pulmonary fibrosis and collagen vascular-related IP) who received oral corticosteroids had a high prevalence of P. jirovecii colonization (23.3%). In IP patients, oral corticosteroid therapy was a significant risk factor for P. jirovecii colonization (P < 0.05). Serum markers did not show differences between IP patients with and without P. jirovecii colonization. The β-D-glucan level and lymphocyte count differed between patients with Pneumocystis pneumonia or P. jirovecii colonization.ConclusionSerum levels of KL-6, SP-A, SP-D, and β-D-glucan were not useful for detecting P. jirovecii colonization in IP patients. However, the serum β-D-glucan level and lymphocyte count were useful for distinguishing P. jirovecii colonization from pneumocystis pneumonia in IP patients.
表面活性剂蛋白 D 可增强免疫抑制小鼠的肺孢子虫感染。
DOI：
10.1152/ajplung.00112.2005
发表时间：
2006
期刊：
American journal of physiology. Lung cellular and molecular physiology
影响因子：
--
作者：
Vuk-Pavlovic,Zvezdana;Mo,EunK;Icenhour,CrystalR;Standing,JosephE;Fisher,JamesH;Limper,AndrewH
通讯作者：
Limper,AndrewH
大鼠卡氏肺孢子虫肺炎期间表面活性蛋白 A 水平升高。
DOI：
10.1183/09031936.96.09030565
发表时间：
1996
期刊：
The European respiratory journal
影响因子：
--
作者：
Phelps,DS;Umstead,TM;Rose,RM;Fishman,JA
通讯作者：
Fishman,JA
艾滋病相关肺炎中表面活性蛋白 A 的恢复增加。
DOI：
10.1164/ajrccm/143.5_pt_1.1072
发表时间：
1991
期刊：
The American review of respiratory disease
影响因子：
--
作者：
Phelps,DS;Rose,RM
通讯作者：
Rose,RM