耶氏肺孢子菌不同病原学染色形态特征在PJP诊断中的效果评价  

Evaluation of the effect of different pathogenic staining morphological characteristics of Pneumocystis jirovecii in the diagnosis of PJP

作　　者：薛婷 王淑峰[2] 杜伟勤 卢鸿 张新日[1] XUE Ting;WANG Shufeng;DU Weiqin;LU Hong;ZHANG Xinri(Department of Respiratory and Critical Care Medicine,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Clinical Laboratory,First Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Department of Medical Laboratory,Lvliang People's Hospital,Lvliang,Shanxi 033000,China)

机构地区：[1]山西医科大学第一医院呼吸与危重症医学科,山西太原030001 [2]山西医科大学第一医院检验科,山西太原030001 [3]山西省吕梁市人民医院医学检验科,山西吕梁033000

出　　处：《检验医学与临床》2020年第24期3557-3560,3564,共5页Laboratory Medicine and Clinic

基　　金：山西省高等学校科技创新项目(2020L0201);中央引导地方科技发展专项资金项目(YDZX20191400002737);山西医科大学省级博士基金项目(SD1905);山西医科大学校级博士启动基金项目(XD1905)。

摘　　要：目的比较耶氏肺孢子菌(P.jirovecii)不同病原学染色形态特征,分析其在肺孢子菌肺炎(PJP)诊断中的价值。方法收集1例PJP患者的支气管肺泡灌洗液,制成涂片,运用不同病原学染色方法分别对其进行染色,分析、评价不同染色方法在PJP诊断中的效果。结果革兰染色和抗酸染色可见透明空泡样结构;真菌荧光染色可见发出蓝色荧光的P.jirovecii包囊;HE染色P.jirovecii包囊囊壁不着色,呈透明晕圈状,囊内可见4~8个囊内小体;Wright-Giemsa染色和改良Giemsa染色可见圆形或卵圆形P.jirovecii包囊,囊壁不着色但折光性强,呈新月形,囊内可见4~8个囊内小体;改良GMS染色P.jirovecii包囊囊壁为深褐色或黑色,呈特征性括弧样结构,囊内小体不着色,中间有1条黑色褶皱或中心点状深染。结论HE染色、Wright-Giemsa染色、改良Giemsa染色、改良GMS染色均可用于确诊PJP,但HE染色、Wright-Giemsa染色、改良Giemsa染色对检验人员要求较高,而改良GMS染色的染色效果好,是临床确诊PJP的推荐病原学染色方法。Objective To compare the morphological characteristics of different pathogenic staining of Pneumocystis jiroveci(P.jirovecii)and analyze its value in the diagnosis of Pneumocystis pneumonia(PJP).Methods A bronchoalveolar lavage fluid sample from a PJP patient was collected and then made smears.Used different pathogenic staining methods to stain them separately,analyzed and evaluated the effect of different staining methods in the diagnosis of PJP.Results Gram staining and acid fast staining showed clear vacuolelike structures.Fungal fluorescence staining showed the blue fluorescent P.jirovecii cyst.The cyst wall of P.jirovecii was not stained by HE staining,showed a transparent halo shape,and every cyst contained 4 to 8 intracystic bodies.Wright-Giemsa staining and modified Giemsa staining showed round or oval P.jirovecii cyst,the cyst wall was not stained but had strong refraction,showed crescent-shaped,and every cyst contained 4 to 8 intracystic bodies.The wall of P.jirovecii cyst was dark brown or black by modified GMS staining,showed a characteristic bracket-like structure,the intracystic bodies were not stained,and there was a black fold or deep staining in the center.Conclusion HE staining,Wright-Giemsa staining,modified Giemsa staining and modified GMS staining can be used to diagnose PJP.However,HE staining,Wright-Giemsa staining and modified Giemsa staining have higher requirements for inspectors.The modified GMS staining is effective,and it is recommended for clinical diagnosis of PJP.

关 键 词：耶氏肺孢子菌 病原学染色 肺孢子菌肺炎 改良GMS染色 

分 类 号：R372[医药卫生—病原生物学]