1341例疑似肺孢子菌肺炎非 HIV 阳性患者病原学诊断分析

摘要

目的：探讨六亚甲基四胺银（gomori’s methenamine silver, GMS）染色镜检法和聚合酶链式反应（polymerase chain reaction, PCR）法检测肺孢子菌肺炎（pneumocystis pneumonia, PCP）患者标本的阳性率，为临床提供更有利的实验室支持依据。方法采集1341例疑似 PCP 患者的深部诱导痰或支气管肺泡灌洗液（broncho-alveolar lavage fluid, BALF）标本， GMS 镜检法和 PCR 法相结合检测肺孢子菌，任何一种方法检测阳性，即判断为 PCP。结果共285例诊断为 PCP，其中114例为 GMS 染色镜检法阳性，282例为 PCR 法检测阳性，111例为2种检测方法双阳性，3例为 GMS 染色镜检法单独阳性（均为肾移植术后 BALF 样品），171例为 PCR 方法单独阳性。深部诱导痰标本中，GMS 染色镜检法和 PCR 法阳性检出率分别为5.1%和16.2%（P＜0.05）；而 BALF 标本二者的阳性检出率分别为23.3%和42.2%（P＜0.05）。未知原因发热合并肺炎患者和器官移植后接受免疫抑制剂治疗者有更高的阳性检出率。结论PCR 法检测 PCP 阳性率高于 GMS 染色镜检法，PCR 法检测与 GMS 染色镜检法结合诊断 PCP 对临床具有较高指导价值。%Objective To discuss the positive rate of Pneumocystis pneumonia (PCP) patients specimens detected by gomori’s methenamine silver (GMS) staining and polymerase chain reaction (PCR) used so as to provide more supportable laboratory basis for clinical practice. Methods A total of 1314 cases of suspected PCP patients with deep induced sputum or broncho-alveolar lavage fluid (BALF) specimens were collected. GMS staining microscopy and PCR method were combined to detect pneumocystis, it could be identified as PCP in the event of any method showing positive. Results A total of 285 patients were diagnosed as PCP, 114 of whom were GMS staining microscopic staining positive, 282 cases were PCR positive, 111 cases were double positive detected by 2 methods, 3 cases were GMS positive staining microscopic alone (all BALF after renal transplantation), and 171 cases of samples were PCR positive alone. In deep induced sputum specimens, GMS staining microscopy and PCR positive rates were 5.1% and 16.2% respectively (P<0.05 and BALF); And in BALF specimens, the positive rates were 23.3% and 42.2% respectively (P < 0.05). Patients with unknown cause fever complicated with pneumonia and organ transplant patients receiving immunosuppressive therapy had higher positive detection rate.Conclusions The positive rate of PCP detected by PCR method is higher than that by GMS staining microscopy, and the detection of PCP by the combination of PCR method and GMS staining microscopy has higher diagnostic value for clinical guidance.