Values Of BG And KL-6 In Sputum Supernatant And Blood In Diagnosis Of AIDS With Pneumocystis Pneumonia

Objective To investigate the clinical value of 1-3-β-D glucan(BG),krebs von den lungen-6(KL-6),BG/KL-6,IL-8,IL-6,TNF-α and IL-4 in sputum supernatant and blood for diagnosing AIDS related PCP,to establish the appropriate cut-off value,and to clarify the relationship between the changes of BG,KL-6 and the clinical therapeutic effect of AIDS with PCP.Methods 1.69 AIDS patients admitted to Hangzhou Xixi Hospital from June 2016 to July 2017 were enrolled in this study,including 27 proven PCP(confirmed by pathological staining and/or molecular biology combined with clinical manifestations),14 possible PCP(only had clinical manifestations),8 PJ colonization(only molecular biology method showed positive)and 20 no final diagnosis of PCP.After treatment,there are 22 proven PCP,5 possible PCP and 6 PJ colonization.Get the induced sputum and blood specimens of patients at admission,7 days after treatment,respectively.The BG concentration was detected by the turbidimetric kinetic method,and KL-6,IL-8,IL-6,TNF-α,IL-4 concentration was detected by ELISA.The baseline data and laboratory indexes of admission patients were collected and analyzed,such as gender,age,underlying disease,CD4+T,LDH,CRP,PCT,Pa O2,white blood cell count,HIV-1 viral load,chest imaging characteristics and treatment conditions.2.The levels of BG,KL-6,BG/KL-6,IL-8,IL-6,TNF-α and IL-4 in sputum supernatant and blood of each group were compared with those of PJ and clinical manifestations.And the sensitivity and specificity of BG,KL-6 was comprehensive analyzed to determine a suitable diagnostic threshold,and to explore the value of BG combined with KL-6 in the diagnosis of PCP in AIDS.3.The changes of BG and KL-6 in sputum supernatant and blood before and after treatment were compared with those of PJ detection clinical efficacy and therapeutic effect of PCP treatment.4.Using SPSS19.0 statistical analysis software to perform statistical analysis.Results 1.The BG concentration in the sputum supernatant of proven PCP was higher than that of the possible PCP,PJ colonization and control group,and the difference was statistically significant between the proven PCP and the PJ colonization(P=0.032),the proven PCP and control group(P=0.008).The sequence of KL-6 concentration in sputum supernatant from high to low is: proven PCP group,possible PCP group,PJ colonization group,control group.And the difference between the proven PCP group and the control group was statistically significant(P=0.035).There were no significant differences in the levels of IL-8,IL-6,TNF-α,IL-4 and BG/KL-6 in the sputum supernatant(P>0.05).2.The BG concentration in the plasma of proven PCP was higher than that of the possible PCP,PJ colonization and control group,and the difference was statistically significant between the proven PCP and control group(P=0.000).The sequence of KL-6 concentration in serum from high to low is: proven PCP group,possible PCP group,control group,PJ colonization group.And the difference was statistically significant(P=0.045).There were no significant differences in the levels of IL-8,IL-6,TNF-α,IL-4 and BG/KL-6 in the serum(P>0.05).3.The area under the curve(AUC)of sputum supernatant and plasma BG in diagnosing AIDS with PCP were 0.729(95%CI 0.582~0.876,P=0.009)and 0.756(95%CI 0.592~0.919,P=0.008),the optimal cutoff value were 17.55 pg/m L and 4.20 pg/m L.Se,Sp,PPV and NPV were 52.0% and 66.7%,90.0% and 86.7%,86.7% and 89.9%,60.0% and 61.9%.The AUC of sputum supernatant and serum KL-6 in diagnosing AIDS with PCP were 0.735(95%CI 0.585~0.885,P=0.007)and 0.625(95%CI 0.443~0.807,P=0.194),the optimal cutoff value were 120.65 U/m L and 139.89 U/m L.Se,Sp,PPV and NPV were 56.0% and 66.7%,85.0% and 62.5%,82.4% and 72.7%,60.7% and 52.9%.The AUC of sputum supernatant and blood BG combined with KL-6 in diagnosing AIDS with PCP were 0.810(95%CI 0.686~0.934,P=0.000)and 0.411(95%CI 0.224~0.599,P=0.356).Se,Sp,PPV and NPV were 76.0% and 45.8%,75.0% and 60.0%,79.2% and 64.7%,71.4% and 40.9%.4.After treatment,the BG decline rate of the sputum supernatant in proven PCP group was 74.80%,and there was a significant difference between before treatment and 7 days after treatment(P=0.004);BG in possible PCP and PJ colonization group had no change,and the difference had no statistically significant(P>0.05).The KL-6 decline rate of the sputum supernatant in proven PCP,possible PCP and PJ colonization group were 85.30%,17.60% and 44.80%,and there was a significant difference in proven PCP group(P=0.000).The differences in possible PCP and PJ colonization group had no statistically significant(P>0.05).The plasma BG decline rate in proven PCP and PJ colonization group were 64.80%,8.60%,and BG in possible PCP group had no change.There was a significant difference of plasma BG in proven PCP group(P=0.003).The serum KL-6 decline rate in proven PCP,possible PCP and PJ colonization group were 13.50%,15.10% and 15.80%,and there were no significant differences among the three groups(P>0.05).Conclusion 1.Sputum supernatant BG,KL-6 and plasma BG in proven PCP group can be used to diagnose AIDS with PCP,and sputum supernatant BG can distinguish proven PCP from PJ colonization.2.BG combined with KL-6 in the sputum supernatant is superior to BG or KL-6 in diagnosing AIDS with PCP.3.Sputum supernatant BG,KL-6 and plasma BG in proven PCP group can reflect the efficacy of AIDS with PCP.