本文選題：耶氏肺孢子菌 + 肺孢子菌肺炎　； 參考：《中國(guó)病原生物學(xué)雜志》2017年10期

【摘要】：目的應(yīng)用靶基因的多重定量PCR方法對(duì)肺孢子菌肺炎(PCP)患者呼吸道標(biāo)本中肺孢子菌進(jìn)行檢測(cè),比較3種方法的檢測(cè)性能。方法提取PCP患者呼吸道標(biāo)本DNA,分別以Pj線粒體大亞基rRNA(mtLSUrRNA)、主要表面糖蛋白(Msg)、二氫葉酸合成酶(DHPS)為靶基因進(jìn)行定量PCR檢測(cè),以臨床診斷為金標(biāo)準(zhǔn)評(píng)價(jià)Mt-qPCR,Msg-qPCR和DHPS-qPCR 3種方法的敏感性、特異性、陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值。結(jié)果Mt-qPCR敏感性95.9%,特異性82.9%,陽(yáng)性預(yù)測(cè)值83.8%,陰性預(yù)測(cè)值95.6%,Youden指數(shù)0.788,受試者工作特征曲線(ROC)下面積0.942(P0.01),95%置信區(qū)間(CI)0.909-0.975;Msg-qPCR敏感性63.9%,特異性92.4%,陽(yáng)性預(yù)測(cè)值88.6%,陰性預(yù)測(cè)值73.5%,Youden指數(shù)0.563,ROC曲線下面積0.795(P0.01),95%CI 0.730-0.860;DHPS-qPCR敏感性49.5%,特異性98.1%,陽(yáng)性預(yù)測(cè)值96.0%,陰性預(yù)測(cè)值67.8%,Youden指數(shù)0.476,ROC曲線下面積0.740(P0.01),95%CI0.669-0.811。PCP診斷組中Mt-qPCR、Msg-qPCR和DHPS-qPCR同時(shí)陽(yáng)性43例(44.3%),任意2種方法陽(yáng)性20例(占20.6%),任意1種方法陽(yáng)性34例(占35.1%);非PCP組中任意2種方法陽(yáng)性5例(占4.8%),任意1種方法陽(yáng)性18例(占17.1%),3種方法均為陰性82例(78.1%),兩組復(fù)合陽(yáng)性率(100%與21.9%)比較差異有統(tǒng)計(jì)學(xué)意義(χ2=127.5,P0.05)。結(jié)論以臨床診斷為金標(biāo)準(zhǔn),Mt-qPCR方法優(yōu)于Msg-qPCR和DHPS-qPCR,聯(lián)合使用含有MtqPCR在內(nèi)的2種以上qPCR方法能提高PCP診斷的符合率。
[Abstract]:Objective to detect Pneumocystis in respiratory tract samples of patients with pneumocystis pneumoniae pneumonia (PCP) by multiplex quantitative PCR with target gene. Methods DNA was extracted from respiratory tract samples of PCP patients. The sensitivity of Mt-qPCRG Msg-qPCR and DHS-qPCR was evaluated by quantitative PCR using PJ mtLSUrRNA, main surface glycoprotein (MSG) and dihydrofolate synthase (DHPS) as target genes. Specificity, positive predictive value and negative predictive value. Results the sensitivity of Mt-qPCR was 95.9, the specificity was 82.9, the positive predictive value was 83.8, the negative predictive value was 95.6and the Youden index was 0.788. The area under the operating characteristic curve (ROC) was 0.942 (P0.01) and 95% confidence interval (CI) 0.909-0.975 Msg-qPCR sensitivity (CI) was 63.9, specificity 92.4m, positive predictive value 88.6, negative predictive value 73.5 and Youden index 0.563ROC curve. Under 0.795 (P0.01), the sensitivity of CI-0.730-0.860 DHPS-qPCR is 49.5%, the specificity is 98.1, the positive predictive value is 96.0 and the negative predictive value is 67.8%. The negative predictive value is 0.740 (P0.01) ~ 95CI0.669-0.811.PCP in the diagnostic group Mt-qPCRG-qPCR and DHPS-qPCR are positive in 43 cases (44.3%), 20 cases (20.6%) are positive for any two methods, and 34 cases are positive for any one method. In the non-PCP group, 5 cases (4.8%) were positive by any two methods, and 82 cases (78.1%) were negative by any one method (17.1%). There was significant difference between the two groups (100% vs 21.9%) (蠂 2 127.5P 0.05). Conclusion Mt-qPCR based on clinical diagnosis is superior to Msg-qPCR and DHPS-qPCR. two or more qPCR methods including MtqPCR can improve the coincidence rate of PCP diagnosis.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院北京熱帶醫(yī)學(xué)研究所熱帶病防治研究北京市重點(diǎn)實(shí)驗(yàn)室;首都醫(yī)科大學(xué)附屬北京朝陽(yáng)醫(yī)院;
【基金】：首都醫(yī)科大學(xué)基礎(chǔ)臨床科研合作基金項(xiàng)目(No.17JL03)
【分類號(hào)】：R440;R563.1

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