BMC Pulmonary Medicine最新文献

Background: Metagenomic next-generation sequencing (mNGS) plays a critical role in the rapid detection of infectious pathogens. We aimed to analyze the clinical characteristics of Pneumocystis jirovecii infection in children without HIV infection and to evaluate the performance of mNGS in distinguishing P. jirovecii colonization from true infection.

Methods: A multicenter, retrospective analysis was conducted on critically ill, non-HIV-infected pediatric patients who tested positive for P. jirovecii via mNGS analysis of bronchoalveolar lavage fluid (BALF). Group differences were assessed using Mann-Whitney U-tests (for continuous data) and chi-square tests (for categorical data). Discriminatory performance was evaluated by calculating the area under the receiver operating characteristic curve.

Results: A total of 59 HIV-negative children (age range: 2 months to 14 years) from four children's hospitals were included and classified into two groups based on P. jirovecii status: P. jirovecii pneumonia (PCP; n = 51) and P. jirovecii colonization (PCC; n = 8). Compared with the PCC group, the PCP group had significantly higher serum C-reactive protein levels and median P. jirovecii read counts in mNGS (both P < 0.05). The optimal threshold value for discriminating P. jirovecii infection from colonization appeared to be 556 reads (sensitivity, 77.6%; specificity, 100.0%). Eighteen patients (35.3%) in the PCP group died. Compared with survivors, these patients were significantly younger, had lower T-cell subset counts (CD3⁺, CD4⁺, and CD8⁺), and a higher prevalence of primary immunodeficiency (all P < 0.05).

Conclusions: BALF mNGS analysis may have utility for differentiating between colonization and infection by P. jirovecii, warranting further investigation.

Introduction: Postoperative pulmonary air leaks is one of the most significant complications, which prolongs hospitalization and increases mortality. The sclerosant interleukin-2 (IL-2) has been widely used in China to reduce postoperative air leaks. However, the optimal suction pressure on digital drainage systems when combined with IL-2 treatment remains elusive among thoracic surgeons. This study aimed to determine the optimal suction pressure provided by digital drainage system, together with IL-2 therapy, for effectively sealing air leaks, and to identify the key factors influencing the healing of air leakage.

Methods: A retrospective analysis involving 94 patients was conducted. The collected information included patient demographics, IL-2 treatment regimens, the average suction pressure applied during the IL-2 therapy period, and air leak duration. The suction pressures were categorized into low (1 ≤ pressure < 5 cmH₂O), medium (5 ≤ pressure < 9 cmH₂O) and high (9 ≤ pressure ≤ 12 cmH₂O) pressure groups. Univariate and multivariate analyses were employed to evaluate the impact of various variables on the time required for air leak sealing. The variables assessed included age, gender, diagnosis, pulmonary complications, resection site, surgery type, operative time, intraoperative blood loss, and suction pressure during IL-2 treatments.

Results: The analysis revealed that suction pressure was a statistically significant determinant of air leak duration (P = 0.036). In multivariate analysis, high suction pressure was independently associated with a longer air leak time by approximately 2.84 days (95% CI: -5.16, -0.52, P = 0.017) and 2.21 days (95% CI: -4.08, -0.35, P = 0.021) compared to low and medium pressure, respectively. Subgroup analysis showed no significant interaction between suction pressure and patient/surgical characteristics, indicating the benefit of lower suction was consistent across the cohort. The number of IL-2 treatments was also a strong predictor of air leak duration (P < 0.001), reflecting the need for repeated therapy in persistent leaks.

Conclusions: Patients receiving IL-2 therapy benefited more from mild suction pressures (low or medium) compared to high suction pressure, resulting in shorter air leak durations across a range of patient and surgical characteristics. These findings support the use of low-to-medium suction (1-9 cmH₂O) as part of the standard management protocol when IL-2 pleurodesis is employed.

Background: Optimal management for first-episode primary spontaneous pneumothorax (PSP) with pulmonary blebs remains uncertain, balancing recurrence prevention against procedural costs. This study compared video-assisted thoracoscopic surgery (VATS) and chest tube drainage in terms of recurrence prevention and cost-effectiveness, incorporating sensitivity analyses to evaluate robustness across variable assumptions.

Methods: In a retrospective cohort (2010-2020), 245 first-episode PSP patients with computed tomography (CT)-confirmed blebs were included. Propensity score matching (1:1, caliper = 0.02) balanced baseline characteristics (age, bleb size, etc.), generating 33 matched pairs. Primary outcomes were recurrence rate and incremental cost-effectiveness ratio (ICER).

Results: VATS reduced 5-year recurrence rates from 48.5% to 12.1% (P = 0.004; absolute risk reduction [ARR] = 36.4%, number needed to treat [NNT] = 2.75) and improved recurrence-free interval (hazard ratio [HR] = 0.166, P < 0.001). The base-case ICER was ¥160,300 per quality-adjusted life-year (QALY) gained (¥48,937 per recurrence avoided), with 99.14% probability of cost-effectiveness at China's World Health Organization (WHO)-recommended willingness-to-pay (WTP) threshold (¥287,247 / QALY). Sensitivity analyses confirmed robustness: ICER remained favorable at ¥156,338 / QALY when pneumothorax utility dropped to 0.5; a 20% cost increase yielded ¥192,200 / QALY. Discount rate variations (3%: ¥159,800 / QALY; 6%: ¥138,029 / QALY) maintained > 98.4% cost-effectiveness probability.

Conclusions: VATS reduces recurrence by 83.4% in first-episode PSP with blebs and demonstrates robust cost-effectiveness. Early surgical intervention should be considered for patients with blebs across diverse resource settings.

Background: Combined immunodeficiency (CID) involves profound defects in B and T lymphocyte development and function. This study examined clinical and immunological phenotypes of CID patients with and without pulmonary manifestations.

Methods: This retrospective multicenter study included 53 CID patients diagnosed between 2009 and 2022 with available thoracic computed tomography scans. Patients were categorized based on pulmonary manifestations presence. Demographic, clinical, and laboratory characteristics were compared using conservative statistical thresholds (P < 0.01). All laboratory parameters were interpreted using age-adjusted pediatric reference ranges.

Results: Among 53 patients (56.6% male), 43 had pulmonary abnormalities on HRCT. Common clinical features included skin lesions (43.4%), failure to thrive (34%), and autoimmunity (32.1%). HRCT revealed pneumonia (28.3%), bronchiectasis (18.9%), interstitial lung disease with BOOP-like pattern (3.8%), and other findings. Using age-adjusted pediatric reference ranges, profound immunological defects were confirmed: absolute lymphocyte count below the 5th percentile in 92% (49/53), CD3 + T cells below the 5th percentile in 94% (47/50 tested), CD4 + T cells below the 5th percentile in 96% (51/53), CD19 + B cells below the 5th percentile in 94% (50/53), and hypogammaglobulinaemia (IgG below the 5th percentile) in 98% (52/53). Patients with abnormal HRCT had significantly lower CD4 + T-cell counts (178 vs. 498 cells/µL; P = 0.008) and CD19 + B-cell counts (42 vs. 189 cells/µL; P = 0.009). Bronchoscopy identified Aspergillus fumigatus, Streptococcus pneumoniae, and multidrug-resistantAcinetobacter baumannii. Deceased patients showed significantly lower baseline platelets (183,000 vs. 266,000 cells/µL; P = 0.009), IgG (380 vs. 720 mg/dL; P = 0.007), and IgE (0.8 vs. 12 IU/mL; P = 0.008).

Conclusion: Pulmonary manifestations affect 81.1% of Iranian CID patients. Low baseline platelets, IgG, and IgE constitute a robust prognostic triad for mortality (P = 0.009, P = 0.007, P = 0.008 respectively). Application of age-adjusted reference ranges revealed profound immunological defects. Systematic HRCT surveillance using low-dose protocols and distinguishing infectious sequelae from immune-mediated lung disease guides targeted management in resource-limited settings.