Serum (1→3)-β-D-glucan measurement as an early indicator of Pneumocystis jirovecii pneumonia and evaluation of its prognostic value
Serum (1→3)-β-D-glucan measurement as an early indicator of Pneumocystis jirovecii pneumonia and evaluation of its prognostic value
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DOI：
10.1111/j.1469-0691.2010.03318.x
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发表时间：
2011-04-01
影响因子：
14.2
通讯作者：
Serr, A.
中科院分区：
文献类型：
--
作者：
Held, J.;Koch, M. S.;Serr, A.
卡氏肺囊虫肺炎（PJP）是免疫功能低下个体疾病的主要原因。然而，直到最近，诊断PJP还没有可靠和特定的血清学参数。（1 - bbb3）- β -d-葡聚糖（BG）是P. jirovecii和其他各种真菌的细胞壁成分。过去几年的数据表明，血清BG测量是诊断PJP的一种很有前途的新工具。因此，我们对50例PJP患者和50例免疫功能低下的对照患者进行了回顾性研究，以评估血清BG测量的诊断性能。我们的结果显示了良好的诊断性能，灵敏度为98.0%，特异性为94%。阳性预测值仅为64.7%，阴性预测值为99.8%，因此BG阴性几乎可以排除PJP。在微生物学诊断前的平均5天和最多21天内，BG水平已经强烈升高，表明该诊断本可以更早得到证实。诊断时的BG水平和随访期间的最大BG水平与患者的预后或通过Real-Time PCR检测到的肺部P. jroveci负担无关。因此，绝对血糖水平似乎没有预后价值。总之，BG是诊断PJP的可靠参数，可作为支气管肺泡灌洗前高危患者的初步检测。
P>Pneumocystis jirovecii (carinii) pneumonia (PJP) is a major cause of disease in immunocompromised individuals. However, until recently no reliable and specific serological parameters for the diagnosis of PJP have been available. (1 -> 3)-beta-d-Glucan (BG) is a cell wall component of P. jirovecii and of various other fungi. Data from the past few years have pointed to serum measurement of BG as a promising new tool for the diagnosis of PJP. We therefore conducted a retrospective study on 50 patients with PJP and 50 immunocompromised control patients to evaluate the diagnostic performance of serum BG measurement. Our results show an excellent diagnostic performance with a sensitivity of 98.0% and a specificity of 94%. While the positive predictive value was only 64.7%, the negative predictive value was 99.8% and therefore a negative BG result almost rules out PJP. BG levels were already strongly elevated in an average of 5 days and up to 21 days before microbiological diagnosis demonstrating that the diagnosis could have been confirmed earlier. BG levels at diagnosis and maximum BG levels during follow-up did not correlate with the outcome of patients or with the P. jirovecii burden in the lung as detected by Real-Time PCR. Therefore, absolute BG levels seem to be of no prognostic value. Altogether, BG is a reliable parameter for the diagnosis of PJP and could be used as a preliminary test for patients at risk before a bronchoalveolar lavage is performed.