特殊染色技术在艾滋病合并真菌病理诊断中的应用  

Application of special staining techniques in pathological diagnosis of fungi infections in HIV/AIDS patients

作　　者：郑叶[1] 曾东[1] 童海涛[1] 杨月香[1] 冯艳玲[1] 卢洪洲[1] 

机构地区：[1]上海市(复旦大学附属)公共卫生临床中心病理科,201508

出　　处：《中华临床感染病杂志》2014年第3期207-211,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：上海市公共卫生体系建设三年行动计划资助项目（GWⅢ-13）

摘　　要：目的 探讨特殊染色技术在艾滋病合并真菌病理诊断中的应用价值.方法 选取2010年2月至2013年11月上海市（复旦大学附属）公共卫生临床中心确诊为艾滋病合并真菌感染的患者20例,回顾性分析经苏木素-伊红（HE）染色、过碘酸希夫染色（PAS）和六胺银染色的病理资料,观察常见真菌在光镜下的形态.结果 20例艾滋病合并真菌感染的患者中,肺部隐球菌2例,皮肤、肺、腹腔肠系膜淋巴结马尔尼菲青霉菌3例,会厌、颈部淋巴结、口腔、腹腔及皮肤组织胞浆菌5例,上颌窦、肺及声带曲霉4例（合并结核3例）,肝、咽、食道及胃部白色假丝酵母菌6例.HE染色组织中炎性细胞浸润,可见肉芽肿形成,凝固性坏死,真菌形态尚能辨认,但需仔细观察,否则易漏诊或误诊;PAS染色,真菌孢子和假菌丝呈亮丽的紫红色,细胞核紫蓝色;六胺银染色,真菌孢子和假菌丝呈清晰可辨的黑褐色.结论 除常规进行HE染色外,联合应用PAS染色和六胺银染色,有助于提高真菌的病理诊断率.Objective To apply special staining techniques in pathological diagnosis of fungal infections in HIV/AIDS patients.Methods Pathological data of 20 HIV/AIDS patients complicated with fungi infections in Shanghai Public Health Clinical Center during February 2010 and November 2013 were retrospectively analyzed.Tissue specimens were stained with hematoxylin and eosin （HE）,Periodic acidSchiff （PAS） and methenamine silver nitrate （MSN）,and the sections were observed under optical microscope.Results Among 20 HIV/AIDS patients complicated with fungi infections,2 were infected with pulmonary cryptococcosis; 3 were penicillium marneffei infections in skin,lung and abdominal mesenteric lymph nodes; 5 were histoplasma capsulatum infections in epiglottis,neck lymph nodes,oral cavity,abdominal cavity and skin; 4 were aspergillus infections in maxillary sinus,lung and vocal cords,and 3 of them were combined with tuberculous lesions; 6 were candida albicans infections in liver,pharynx,esophagus and stomach.In tissues stained with HE the infiltration of inflammatory cells,granuloma formation and coagulative necrosis were observed,and the shape of fungi needed careful observation to avoid missed diagnosis and misdiagnosis.In tissues stained with PAS,fungal spores and pseudohypha were presented in bright amaranth,and cell nucleus was in purple-blue.In tissues stained with MSN,fungal spores and pseudohypha were identified clearly in brown-black.Conclusion HE plus PAS and MSN staining will help pathological diagnosis of fungi infection.

关 键 词：获得性免疫缺陷综合征 真菌 病理诊断 苏木素-伊红染色 过碘酸希夫染色 六胺银染色 

分 类 号：R512.91[医药卫生—内科学] R519[医药卫生—临床医学]