目的 评价重组人源肺孢菌主要表面糖蛋白C(Msg C)共有抗原在肺孢菌肺炎(PCP)诊断中的临床价值, 以探索PCP的血清学诊断新方法.方法 建立检测血清抗人源肺孢菌Msg C共有抗原IgM抗体酶联免疫吸附测定(ELISA)方法, 对48例PCP高危人群(高危组)和51名健康人群(对照组)血清进行抗Msg C共有抗原IgM抗体和(1, 3)-β-D葡聚糖检测, 并与支气管肺泡灌洗液的PCR结果进行比较分析.结果 总共99例标本中抗Msg C共有抗原IgM抗体检测和(1, 3)-β-D葡聚糖检测阳性率分别为28.3％(28/99)和25.3％(25/99), P>0.05;高危组48例标本中两者阳性率分别为35.4％(17例)和33.3％(16例), P>0.05;两种检测方法在总共99例标本和高危组标本检验结果一致性分别为67.7％和52.1％.高危组支气管肺泡灌洗液标本PCR检测15例阳性, 与抗Msg C共有抗原IgM抗体检测差异无统计学意义(P=0.665);抗Msg C共有抗原IgM抗体检测与PCR检测结果一致性为58.3％;在两种血清学方法检验结果一致的25例标本中, 与PCR检验结果一致性提升到84.0％;若以任一种血清学阳性结果作为判读阳性标准, 高危组15例PCR阳性标本检出率达86.7％(13/15).结论 抗Msg C共有抗原IgM抗体联合血清学指标(1, 3)-β-D葡聚糖检测对PCP诊断具有一定价值, 两者均为阳性时应进一步进行下呼吸道标本PCR检测和传统细胞学染色检查.%Objective To evaluate the clinical value of recombinant major surface glycoprotein C(Msg C)consensus antigen of Pneumocystis jirovecii in serological diagnosis of Pneumocystis pneumonia(PCP), and explore serological diagnosis for PCP. Methods ELISA method was established for testing IgM antibody of Pneumocystis jirovecii Msg C consensus antigen. Serum antiMsg C consensus antigen IgM antibody and(1, 3)-β-D glucan were determined in 48 patients at high risk of PCP and 51 healthy subjects. The results of ELISA and(1, 3)-β-D glucan assay were compared with the results of PCR in bronchoalveolar lavage fluid. Results In a total of 99 specimens, Msg C consensus antigen IgM antibody detection(28.3％, 28/99)showed similar positive rate as(1, 3)-β-D glucan assay(25.3％, 25/99)(P>0.05). For the 48 patients at high risk of PCP, the positive rate of Msg C consensus antigen IgM antibody and(1, 3)-β-D glucan assay was 35.4％(17/48)and 33.3％(16/48), respectively(P>0.05). The two methods showed 67.7％ agreement in testing 99 specimens and 52.1％ agreement in testing 48 high-risk specimens. The bronchial lavage fluid samples of 48 patients at high risk were also tested by PCR. The result was positive in 15 cases(31.3％), showing no significant difference from Msg C consensus antigen IgM antibody test(P=0.665). The agreement between Msg C consensus antigen IgM antibody test and PCR was 58.3％. The agreement with PCR result increased to 84.0％ in the 25 specimens with the same result by two serological methods.When taking the positive result of either serological method as reference, serological method can detect majority of the PCR positive cases(86.7％, 13/15). Conclusions IgM antibody against Msg C consensus antigen in combination with serological marker(1, 3)-β-D glucan is valuable for PCP diagnosis. Further examination such as lower respiratory tract specimen PCR and conventional cytology should be carried out to confirm the diagnosis when both IgM antibody against Msg C consensus antigen and(1, 3)-β-D glucan are positive.
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