卡氏肺孢子菌肺炎血清学指标的研究  

Diagnostic value of serum indicators for Pneumocystis cariniipneumonia

作　　者：吴欢欢 李玉苹[2] 陈成水[2] 叶民[2] 周颖[2] 杨芳芳[2] 

机构地区：[1]东阳市人民医院呼吸科,浙江东阳322100 [2]温州医学院附属第一医院呼吸内科,浙江温州325000

出　　处：《中华医院感染学杂志》2013年第8期1769-1771,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药课题研究计划(2007CA088)

摘　　要：目的研究血清学指标乳酸脱氢酶(LDH)、C反应蛋白(CRP)、肺泡Ⅱ型上皮细胞抗原(KL-6)、1→3-β-D-葡聚糖(1→3-β-D-glucan,BDG)作为辅助检测手段对大鼠卡氏肺孢子菌肺炎(PCP)的诊断价值,并对其进行治疗。方法清洁级SD(Sprague-Dawley)大鼠24只,体重180～200g,随机分为磺胺甲噁唑/甲氧苄啶治疗组、卡泊芬净治疗组、PCP模型对照组及正常对照组4组,予地塞米松致免疫抑制,诱导建立PCP动物模型,造模成功后分别以磺胺甲噁唑/甲氧苄啶灌胃、卡泊芬净腹腔注射干预实验鼠,各组动物分别于给药第4、8天及干预结束观察满1周,3个时间点取血,用ELISA法检测血清乳酸脱氢酶(LDH)、C反应蛋白(CRP)、肺泡Ⅱ型上皮细胞抗原(KL-6)、BDG浓度,并观察上述指标在实验中不同时间段的变化,同时用real-time PCR法检测药物干预前后PCP大鼠体内真菌DNA表达量的变化。结果正常组大鼠血清BDG、KL-6、LDH值明显低于模型对照组动物(P<0.05);磺胺甲噁唑/甲氧苄啶治疗组及卡泊芬净治疗组大鼠血清BDG、KL-6、LDH值明显低于模型对照组动物(P<0.05);在药物干预不同时间段,大鼠各血清学指标值呈时间依赖性,真菌DNA表达量也明显下降。结论血清学指标BDG是PCP较为可靠的辅助检测手段,联合血清KL6、LDH对大鼠PCP有一定的诊断价值。OBJECTIVE To study the value of the serum indicators including the lactate dehydrogenase（LDH）,C-reactive protein,type Ⅱ alveolar epithelial cell antigen（KL-6）,and 1→3-β-D-glucan（BDG） in diagnosis of Pneumocystis carinii pneumonia（PCP）in rats so as to guide the clinical treatment.METHODS Totally 24 SD rats weighting between 180 to 200 grams were randomly divided into 4 groups： SMZCO therapy group,caspofungin therapy group,PCP model group,and the control group.The PCP animal model was established by subcutaneous injection with dexamethasone.After the model with positive result of GMS stain in bronchoalveolar lavage sediment smear and lung tissue was established,the rats were administered with SMZCO and caspofungin respectively,then the value of LDH,CRP,KL-6,and BDG in serum were measured with ELISA,and the dynamic values in different time periods were recorded.At the same time,the load of fungal DNA was examined with real-time PCR.RESULTS The value of serum indicators of BDG,KL-6,or LDH in the normal group was significantly lower than that in the model control group（P0.05）.The value of the serum indicators of BDG,LDH,or KL-6 in the rats treated with SMZCO and caspofungin were significantly lower than that of the rats in the model control group（P0.05）.The serum indicators presented the time-dependent manner at different drug intervention periods,and load of fungal DNA also decreased.CONCLUSION The value of serum indicators of KL-6,BDG,or LDH is helpful in the adjuvant diagnosis of PCP in rats.

关 键 词：乳酸脱氢酶 C反应蛋白 肺泡Ⅱ型上皮细胞抗原 1→3-β-D-葡聚糖 卡氏肺孢子菌肺炎 诊断 

分 类 号：R378[医药卫生—病原生物学]