高分辨率计算机断层扫描（HRCT）对肾移植肺部感染患者检测卡氏肺孢子虫的诊断准确性：一项以支气管肺泡灌洗为金标准的研究

Diagnostic Accuracy of High-Resolution Computed Tomography (HRCT) in Detecting Pneumocystis carinii in Renal Transplant Patients With Pulmonary Infection: A Study Using Bronchoalveolar Lavage As the Gold Standard.

作者信息

Fazal Kamran, Muhammad Azeemuddin, Sattar Muhammad A, Iqbal Junaid, Siddiqui Irfan, Fazal Adnan

机构信息

Radiology, Aga Khan University Hospital, Karachi, PAK.

Radiology, Sindh Institute of Urology and Transplantation, Karachi, PAK.

出版信息

Cureus. 2024 Nov 30;16(11):e74831. doi: 10.7759/cureus.74831. eCollection 2024 Nov.

DOI:10.7759/cureus.74831

PMID:39737261

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11684350/

Abstract

INTRODUCTION

Patients receiving renal transplants have weakened immune systems and are more vulnerable to lung infections.

OBJECTIVES

To determine the diagnostic accuracy of high-resolution computed tomography (HRCT) in detecting pneumocystis carinii in renal transplant patients presenting with pulmonary infection in a tertiary care transplant center, keeping bronchoalveolar lavage (BAL) as the gold standard.

METHODS

This cross-sectional study was conducted at the Department of Radiology, Sindh Institute of Urology and Transplant, Karachi, from February 14, 2023, to August 13, 2023. Using a non-probability consecutive sampling technique, we enrolled 81 post-renal transplant patients, aged 20 to 60 years, of both genders, who were receiving immunosuppressive therapy and referred to the Radiology Department for HRCT as part of a workup for pulmonary infection. Patients presented with pulmonary infection underwent HRCT and BAL. Diagnostic accuracy was determined and data was analyzed.

RESULTS

In this study, 81 patients were enrolled with a mean age of 35.4±11.3 years. There were 56 (69.1%) male and 25 (30.9%) female patients. The mean duration of renal transplant was 18.09±12.8 months. The mean duration of symptoms was 5.32±2 days. Diabetes was present in 43 (53.1%) patients. The sensitivity of HRCT in diagnosing pneumocystis carinii was 93%, specificity was 91.7%, positive predictive value was 96.4%, negative predictive value was 84.6%, and diagnostic accuracy was 92.5%, taking BAL as the gold standard.

CONCLUSION

HRCT is a good imaging modality to diagnose pneumocystis carinii in renal transplant patients.

摘要

引言

接受肾移植的患者免疫系统较弱，更容易受到肺部感染。

目的

在一家三级医疗移植中心，以支气管肺泡灌洗（BAL）作为金标准，确定高分辨率计算机断层扫描（HRCT）对肾移植患者肺部感染时检测卡氏肺孢子虫的诊断准确性。

方法

本横断面研究于2023年2月14日至2023年8月13日在卡拉奇信德泌尿与移植研究所放射科进行。采用非概率连续抽样技术，我们纳入了81例年龄在20至60岁之间、正在接受免疫抑制治疗且因肺部感染检查而被转诊至放射科进行HRCT检查的肾移植术后患者。出现肺部感染的患者接受了HRCT和BAL检查。确定诊断准确性并进行数据分析。

结果

本研究纳入了81例患者，平均年龄为35.4±11.3岁。其中男性56例（69.1%），女性25例（30.9%）。肾移植的平均时长为18.09±12.8个月。症状的平均持续时间为5.32±2天。43例（53.1%）患者患有糖尿病。以BAL作为金标准，HRCT诊断卡氏肺孢子虫的敏感性为93%，特异性为91.7%，阳性预测值为96.4%，阴性预测值为84.6%，诊断准确性为92.5%。