胸部CT评估艾滋病相关肺孢子菌肺炎宿主的免疫状态
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摘要
目的探讨胸部CT在评估艾滋病相关肺孢子菌肺炎宿主免疫状态中的应用价值。资料与方法回顾性分析符合艾滋病相关肺孢子菌肺炎临床诊断标准的82例患者的胸部CT薄层图像,根据其特征性CT表现的范围及密度进行CT综合定量评分,获取评分值,并与最近的CD_4~+T淋巴细胞计数进行相关性分析,通过受试者工作特征曲线分析,获取CT综合定量评分值预测CD_4~+T淋巴细胞绝对计数<50个/μl的最佳临界值。结果艾滋病相关肺孢子菌肺炎特征性病变的CT综合定量评分值与最近CD_4~+T淋巴细胞计数呈线性负相关(r=-0.47,P<0.01)。以CD_4~+T淋巴细胞绝对计数<50个/μl为阈值,通过受试者工作特征曲线分析,得出相应CT综合定量评分预测值为>48.25分,其曲线下面积为0.80(P<0.01),敏感度为83.10%,特异度为73.90%,阳性预测值为89.09%,阴性预测值为50.67%。结论胸部CT定量评分有助于初步预测艾滋病相关肺孢子菌肺炎宿主的免疫状态,对早期诊疗及评估预后具有重要的临床参考价值。
Purpose To explore the application value of chest CT in assessing host immune status of acquired immunodeficiency syndrome(AIDS)-related pneumocystis jirovecii pneumonia. Materials and Methods Chest CT images of 82 patients that met clinical diagnostic criteria for AIDS-related pneumocystis pneumonia were retrospectively analyzed. CT comprehensive quantitative scoring was performed as per the range and density of characteristic CT findings, and the scores obtained were used for statistical correlation analysis with up-to-date CD_4~+ T lymphocyte counts. Meanwhile, CT comprehensive quantitative scores obtained by analyzing the receiver operating characteristic curve were used for estimation of the optimal cut-off value of CD_4~+ T lymphocytes whose absolute counting<50/μl. Results The CT comprehensive quantitative scores of characteristic lesions of AIDS-related pneumocystis pneumonia bore low linear negative correlation with the up-to-date CD_4~+ T lymphocyte counts(r=-0.47, P<0.01). By analyzing the receiver operating characteristic curve, the predicated value of corresponding CT comprehensive quantitative score reached>48.25 points, the area under curve was 0.80(P<0.01), the sensitivity was 83.10%, the specificity was 73.90%, the positive predictive value was 89.09%, and the negative predictive value was 50.67%, with the absolute counting of CD_4~+ T lymphocytes<50/μl being the threshold value. Conclusion Chest CT quantitative scoring is conducive to preliminary prediction of host immune status of AIDS-related pneumocystis pneumonia,featuring essential clinical reference value for diagnosis and treatment in early stage as well as prognosis evaluation.
Purpose To explore the application value of chest CT in assessing host immune status of acquired immunodeficiency syndrome(AIDS)-related pneumocystis jirovecii pneumonia. Materials and Methods Chest CT images of 82 patients that met clinical diagnostic criteria for AIDS-related pneumocystis pneumonia were retrospectively analyzed. CT comprehensive quantitative scoring was performed as per the range and density of characteristic CT findings, and the scores obtained were used for statistical correlation analysis with up-to-date CD_4~+ T lymphocyte counts. Meanwhile, CT comprehensive quantitative scores obtained by analyzing the receiver operating characteristic curve were used for estimation of the optimal cut-off value of CD_4~+ T lymphocytes whose absolute counting<50/μl. Results The CT comprehensive quantitative scores of characteristic lesions of AIDS-related pneumocystis pneumonia bore low linear negative correlation with the up-to-date CD_4~+ T lymphocyte counts(r=-0.47, P<0.01). By analyzing the receiver operating characteristic curve, the predicated value of corresponding CT comprehensive quantitative score reached>48.25 points, the area under curve was 0.80(P<0.01), the sensitivity was 83.10%, the specificity was 73.90%, the positive predictive value was 89.09%, and the negative predictive value was 50.67%, with the absolute counting of CD_4~+ T lymphocytes<50/μl being the threshold value. Conclusion Chest CT quantitative scoring is conducive to preliminary prediction of host immune status of AIDS-related pneumocystis pneumonia,featuring essential clinical reference value for diagnosis and treatment in early stage as well as prognosis evaluation.
引文
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[6]谢浩锋,黄翔,郑晓林,等.艾滋病合并肺孢子菌肺炎渗出性病变CT定量评分与血清乳酸脱氢酶的相关性分析.新发传染病电子杂志,2018,3(1):15-20.
[7]Casarini M,Ameglio F,Alemanno L,et al.Cytokine levels correlate with a radiologic score in active pulmonary tuberculosis.Am J Respir Crir Care Med,1999,159(1):143-148.
[8]Chou CW,Chao HS,Lin FC,et al.Clinical usefulness of HRCT in assessing the severity of pneumocystis jirovecii pneumonia:a cross-sectional study.Medicine(Baltimore),2015,94(16):e768.
[9]谢正平,朱斌.艾滋病合并肺孢子菌肺炎的CT表现分型与预后相关性.临床放射学杂志,2018,37(2):228-232.
[10]蒋丽华,李宏军,王仁贵,等.艾滋病合并肺孢子菌肺炎的CT表现与CD4+T淋巴细胞计数的关系.中国煤炭工业医学杂志,2016,19(6):831-835.
[11]李航,陈艳芳,汪明月,等.间质型肺孢子菌肺炎的HRCT表现.放射学实践,2018,33(6):561-564.
[12]Buchacz K,Lau B,Jing Y,et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada,2000-2010.J Infect Dis,2016,214(6):862-872.
[13]Desiree DP,Bhavani P,Veerle M,et al.Laboratory-based surveillance of pneumocystis jirovecii pneumonia in South Africa.Southern African Journal of Infectious Diseases,2016,31(1):8-13.
[14]Siegel M,Masur H,Kovacs J,et al.Pneumocystis jirovecii pneumonia in human immunodeficiency virus infection.Semin Respir Crit Care Med,2016,37:243-256.
[15]张永萍,牛新荣.231例艾滋病患者临床特征分析.中华实验和临床感染病杂志:电子版,2010,4(4):415-419.
[16]Forebel KS,Raab GM,D'alessandro C,et al.A single measurement of CD38,CD3 cells in HIV+,long term surviving injecting drugs uses distinguishes these who will progress to AIDS from those who will remain stable.Clin Exp Immunol,2000,122(1):72-78.
[2]Anyimadu H,Pingili C,Sivapalan V,et al.The impact of absolute CD4 count and percentage discordance on pneumocystis jirovecii pneumonia prophylaxis in HIV-infected patients.J Int Assoc Provid AIDS Care,2018,17:1-4.
[3]Mellors JW,Mu?oz A,Giogi JV,et al.Plasma viral load and CD4+lymphocytes as prognostic markers of HIV-1 infection.Ann Intern Med,1997,126(12):946-954.
[4]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版).中华临床感染病杂志,2015,8(5):385-401.
[5]谢正平,朱斌.艾滋病合并肺孢子菌肺炎的CT表现分型与CD4+T淋巴细胞的相关性.中国医学影像学杂志,2017,25(6):447-451.
[6]谢浩锋,黄翔,郑晓林,等.艾滋病合并肺孢子菌肺炎渗出性病变CT定量评分与血清乳酸脱氢酶的相关性分析.新发传染病电子杂志,2018,3(1):15-20.
[7]Casarini M,Ameglio F,Alemanno L,et al.Cytokine levels correlate with a radiologic score in active pulmonary tuberculosis.Am J Respir Crir Care Med,1999,159(1):143-148.
[8]Chou CW,Chao HS,Lin FC,et al.Clinical usefulness of HRCT in assessing the severity of pneumocystis jirovecii pneumonia:a cross-sectional study.Medicine(Baltimore),2015,94(16):e768.
[9]谢正平,朱斌.艾滋病合并肺孢子菌肺炎的CT表现分型与预后相关性.临床放射学杂志,2018,37(2):228-232.
[10]蒋丽华,李宏军,王仁贵,等.艾滋病合并肺孢子菌肺炎的CT表现与CD4+T淋巴细胞计数的关系.中国煤炭工业医学杂志,2016,19(6):831-835.
[11]李航,陈艳芳,汪明月,等.间质型肺孢子菌肺炎的HRCT表现.放射学实践,2018,33(6):561-564.
[12]Buchacz K,Lau B,Jing Y,et al.Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada,2000-2010.J Infect Dis,2016,214(6):862-872.
[13]Desiree DP,Bhavani P,Veerle M,et al.Laboratory-based surveillance of pneumocystis jirovecii pneumonia in South Africa.Southern African Journal of Infectious Diseases,2016,31(1):8-13.
[14]Siegel M,Masur H,Kovacs J,et al.Pneumocystis jirovecii pneumonia in human immunodeficiency virus infection.Semin Respir Crit Care Med,2016,37:243-256.
[15]张永萍,牛新荣.231例艾滋病患者临床特征分析.中华实验和临床感染病杂志:电子版,2010,4(4):415-419.
[16]Forebel KS,Raab GM,D'alessandro C,et al.A single measurement of CD38,CD3 cells in HIV+,long term surviving injecting drugs uses distinguishes these who will progress to AIDS from those who will remain stable.Clin Exp Immunol,2000,122(1):72-78.