■已在小型研究中评估了胸部X射线(CXR)特征对肺孢子菌肺炎(PCP)诊断的表现。我们进行了系统评价和荟萃分析,以描述患有HIV相关实验室确诊的PCP的成年人的CXR变化。将这些与非PCP呼吸道疾病进行比较。
我们在数据库中搜索了报告15岁以上HIV感染者和实验室确诊的PCP患者以及非PCP呼吸道疾病患者CXR变化的研究。使用共识术语对CXR特征进行分组。使用随机效应荟萃分析汇总比例并生成比值比(OR),通过CD4计数进行亚组分析,学习期间,放射学审查方法,研究区域。
■纳入51项研究(包括1821例PCP和1052例非PCP病例)。间质浸润(59%;95%CI,52%-66%;36项研究,n=1380;I2=85%)和毛玻璃混浊(48%;95%CI,15%-83%;4项研究,n=57;I2=86%)在PCP中很常见。囊性病变,中央淋巴结病,气胸很少见。胸腔积液在PCP中很少见(0%;95%CI,0%-2%)。间质浸润(或,2.3;95%CI,1.4-3.9;I2=60%),间质-肺泡浸润(OR,10.2;95%CI,3.2-32.4;I2=0%),和弥漫性CXR变化(或,7.3;95%CI,2.7-20.2;I2=87%)与PCP诊断相关。在非洲研究中,与肺泡浸润的相关性丧失。
■弥漫性CXR改变和间质肺泡浸润表明PCP的可能性更高。胸腔积液,淋巴结病,和局灶性肺泡浸润提示其他原因。这些发现可以纳入临床算法以改善HIV相关PCP的诊断。
UNASSIGNED: The performance of chest x-ray (CXR) features for Pneumocystis pneumonia (
PCP) diagnosis has been evaluated in small studies. We conducted a systematic review and meta-analysis to describe CXR changes in adults with HIV-associated laboratory-confirmed PCP, comparing these with non-
PCP respiratory disease.
UNASSIGNED: We searched databases for studies reporting CXR changes in people >15 years old with HIV and laboratory-confirmed PCP and those with non-
PCP respiratory disease. CXR features were grouped using consensus terms. Proportions were pooled and odds ratios (ORs) generated using random-effects meta-analysis, with subgroup analyses by CD4 count, study period, radiology review method, and study region.
UNASSIGNED: Fifty-one studies (with 1821
PCP and 1052 non-
PCP cases) were included. Interstitial infiltrate (59%; 95% CI, 52%-66%; 36 studies, n = 1380; I2 = 85%) and ground-glass opacification (48%; 95% CI, 15%-83%; 4 studies, n = 57; I2 = 86%) were common in PCP. Cystic lesions, central lymphadenopathy, and pneumothorax were infrequent. Pleural effusion was rare in
PCP (0%; 95% CI, 0%-2%). Interstitial infiltrate (OR, 2.3; 95% CI, 1.4-3.9; I2 = 60%), interstitial-alveolar infiltrate (OR, 10.2; 95% CI, 3.2-32.4; I2 = 0%), and diffuse CXR changes (OR, 7.3; 95% CI, 2.7-20.2; I2 = 87%) were associated with PCP diagnosis. There was loss of association with alveolar infiltrate in African studies.
UNASSIGNED: Diffuse CXR changes and interstitial-alveolar infiltrates indicate a higher likelihood of PCP. Pleural effusion, lymphadenopathy, and focal alveolar infiltrates suggest alternative causes. These findings could be incorporated into clinical algorithms to improve diagnosis of HIV-associated PCP.