河北地区临床实验室丝状真菌分离鉴定情况分析  

Analysis of filamentous fungi isolations from clinical laboratories in Hebei province

作　　者：赵颖 李志荣[2] 赵建宏[2] 栗方 董爱英 刘金禄 郭彦言 谢守军[7] 吴相锟 郭秀华 王建升 张金艳 刘冬青[12] 魏宏莲 孙艳[14] 赵文申 任宏涛 郭映辉 肖盟 徐英春 徐晓琳 王军爽 杨文航 ZHAO Ying;LI Zhi-rong;ZHAO Jian-hong;LI Fang;DONG Ai-ying;LIU Jin-lu;GUO Yan-yan;XIE Shou-jun;WU Xiang-kun;GUO Xiu-hua;WANG Jian-sheng;ZHANG Jin-yan;LI Dong-qing;WEI Hong-lian;SUN Yan;ZHAO Wen-shen;REN Hong-tao;GUO Ying-hui;XIAO Meng;XU Ying-chun;XU Xiao-lin;WANG Jun-shuang;YANG Wen-hang(Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases,Beijing 100730,China;The Second Hospital of Hebei Medical University,Clinical Laboratory Center of Hebei Province,Heibei 050000,China;Hebei Yanda hopstial,Langfang 065201,China;Chao yang Hospital Affilliated to the Capital University of Medical Science,Beijing 100020,China;North China University of Science and Technology Affiliated Hospital,Tangshan 06300,China;The First Affiated Hospital of Hebei North University,Zhangjiakou 075000,China;Affiated Hospital of Chengde Medical University,Chengde 067000,China;Tangshan Gongren Hospital,Tangshan 063000,China;Wu’an First People’s Hospital,Wu’an 056300,China;Hebei General Hospital,Shijiazhuang 050057,China;The Fourth Hospital of Hebei Medical University,Shijiazhuang 050000,China;Handan First Hospital,Handan 056002,China;The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Cangzhou Central Hospital,Cangzhou 061001,China;Handan Central Hospital,Handan 056001,China;Xingtai People’s Hospital,Xingtai 054001,China)

机构地区：[1]中国医学科学院北京协和医院检验科侵袭性真菌病机制研究与精准诊断北京市重点实验室,北京100730 [2]河北医科大学第二医院河北省临床检验中心,石家庄050000 [3]河北燕达医院感染与疾病控制部,廊坊065201 [4]首都医科大学附属北京朝阳医院感染与微生物科,北京100020 [5]华北理工大学附属医院,唐山063000 [6]河北北方学院附属第一医院,张家口075000 [7]承德医学院附属医院,承德067000 [8]河北省唐山市工人医院,唐山063000 [9]河北燕达医院,廊坊065201 [10]河北省武安市第一人民医院,武安056300 [11]河北省人民医院,石家庄050057 [12]河北医科大学第四医院,石家庄050019 [13]邯郸市第一医院,邯郸056002 [14]河北医科大学第二医院,石家庄050000 [15]沧州市中心医院,沧州061001 [16]邯郸市中心医院,邯郸056001 [17]邢台市人民医院,邢台054001

出　　处：《中国真菌学杂志》2020年第4期206-212,共7页Chinese Journal of Mycology

基　　金：河北省科技计划项目(17277775D);中央高校基本科研业务费专项资金资助项目(3332018041);辉瑞中国抗真菌科研基金项目资助(WS931592)。

摘　　要：目的开展一项由河北地区多所医院参与的临床实验室丝状真菌检测研究,促进实验室丝状真菌检测能力提升。方法共收集丝状真菌菌株,采用沙堡弱培养基和乳酸酚棉兰染色直接镜检进行菌种常规鉴定;中心实验室采用Vitek MS质谱进行复核鉴定,对MS不能有效鉴定的菌种进行核糖体DNA内转录间隔区ITS和/或钙调蛋白CaM测序分析。结果参与研究的15家三级医院2016~2017年共收集到丝状真菌225株。其中烟曲霉133株(59.11%)、黄曲霉/米曲霉28株(12.44%)、黑曲霉复合群18株(8.00%)、聚多曲霉6株(2.67%)、构巢曲霉6株(2.67%)、其他丝状真菌34株(15.11%)。样本类型包括下呼吸道痰标本203株(90.22%),耳道分泌物10株(4.44%),肺泡灌洗液4株(1.78%),其他样本8株(3.56%)。菌株鉴定正确率(148/225)65.78%,错误率(77/225)34.22%。结论丝状真菌感染中最常见的是曲霉菌属,主要以烟曲霉菌、黄曲霉菌和黑曲霉菌为主。传统的鉴定方法错误率高达30%以上,采用微生物质谱鉴定结合ITS/CaM区测序方法可以有效提高丝状真菌的鉴定正确率,为临床丝状真菌的治疗提供病原学依据。Objective To investigate the current status of filamentous fungal infections in 15 tertiary teaching hospitals in Hebei province from 2016 to 2017,and to understand the epidemiological characteristics of filamentous fungal infections in Hebei.Methods Filamentous fungi were collected and counted.Sabouraud Dextrose Agar(SDA)and lactophenol cotton blue staining were used for culture and direct microscopic screening and preliminary identification.Vitek MS was used for re-identification of all the strains and ITS and/or calmodulin sequencing analysis was used to identify the strains which were rare or hard to identify.Results A total of 225 filamentous fungi were collected in 15 tertiary teaching hospitals from 2016 to 2017.Among them,133 strains of Aspergillus fumigatus(59.11%),28 strains of Aspergillus flavus/Aspergillus oryzae(12.44%),18 strains of Aspergillus niger(8.00%),6 strains of Aspergillus sydowii(2.67%),6 strains of Aspergillus nidulans(2.67%),and 34 strains of other filamentous fungi(15.11%).Specimen types included sputum(203,90.22%),ear canal secretion(10,4.44%),bronchoalveolar lavage fluid(4,1.78%),and 8 other types(3.56%).The accurate identification rate(148/225)was 65.78%,and the mis-identification rate(77/225)was 34.22%.Conclusion The most common filamentous fungal infection pathogen were Aspergillus spp.,mainly Aspergillus fumigatus,Aspergillus flavus and Aspergillus niger.The mis-identification rate of traditional identification methods is higher than 30%.Using mass spectrometry method combined with ITS/CAM sequencing analysis could effectively improve the identification accuracy of filamentous fungi and provide precise etiological basis for clinical treatment.

关 键 词：丝状真菌 分布特征 复核鉴定 

分 类 号：R379.2[医药卫生—病原生物学]