1,3-β-D-葡聚糖在非HIV感染者合并肺孢子菌肺炎中的诊断价值

Diagnostic value of 1,3-β-D-glucan in Pneumocystis pneumonia in human immunodeficiency virus-uninfected patients

目的探讨血清1,3-β-D-葡聚糖(BDG)在非人类免疫缺陷病毒(HIV)感染合并肺孢子菌肺炎(PCP)患者中的诊断价值。方法本研究为病例对照研究。采用非随机抽样方法,分析北京协和医院2015年1月至2019年12月收治的非HIV感染免疫功能低下合并肺炎患者的临床资料,根据支气管肺泡灌洗液肺孢子菌聚合酶链反应(PCR)结果将其分为肺孢子菌PCR阳性组和肺孢子菌PCR阴性组,对其血清BDG结果进行统计分析。结果共纳入非HIV感染免疫功能低下合并肺炎患者132例,其中肺孢子菌PCR阳性37例,肺孢子菌PCR阴性95例,肺孢子菌PCR阳性组的BDG水平高于肺孢子菌PCR阴性组[377.4(174.0,913.2)ng/L比28.3(14.6,74.3)ng/L,Z=7.73,P<0.001],BDG诊断非HIV感染者合并PCP的受试者工作特征曲线的曲线下面积为0.933,以BDG的诊断临界值为95 ng/L时,其敏感度为86.5%,特异度为86.3%,阳性预测值为71.1%,阴性预测值为94.3%。恶性肿瘤患者中,其敏感度为88.9%,特异度为93.1%,阳性预测值为80.0%,阴性预测值为96.4%。结论血清BDG在非HIV感染免疫功能低下(尤其是恶性肿瘤)合并PCP患者中具有一定的辅助诊断和较高的排除诊断价值。

Objective To explore the diagnostic value of serum 1,3-β-D-glucan(BDG)in human immunodeficiency virus(HIV)-uninfected immunocompromised patients complicated with Pneumocystis pneumonia(PCP).Methods This was a case-control study.Non-random sampling was used.The clinical data of HIV-uninfected immunocompromised patients with pneumonia in Peking Union Medical College Hospital from January 2015 to December 2019 were retrospectively analyzed.According to the results of pneumocystis polymerase chain reaction(PCR)in bronchoalveolar lavage fluid,patients were divided into Pneumocystis PCR positive group and Pneumocystis PCR negative group.The serum BDG levels were statistically analyzed.Results A total of 132 pneumonia in HIV-uninfected immunocompromised patients were included,with 37 cases Pneumocystis PCR positive and 95 cases Pneumocystis PCR negative.The level of BDG in Pneumocystis PCR positive group was significantly higher than that in Pneumocystis PCR negative group[377.4(174.0,913.2)ng/L vs 28.3(14.6,74.3)ng/L,Z=7.73,P<0.001].The area under curve was 0.933.BDG≥95 ng/L had a sensitivity of 86.5%,specificity of 86.3%,positive predictive value(PPV)of 71.1%,and negative predictive value(NPV)of 94.3%for PCP.In patients with malignant tumors,BDG had a sensitivity of 88.9%,specificity of 93.1%,PPV of 80.0%,and NPV of 96.4%.Conclusions Serum BDG has certain auxiliary diagnostic value and high exclusion diagnostic value in HIV-uninfected immunocompromised(especially malignant tumor)patients with PCP.