HIV感染/AIDS患者感染性浅表淋巴结病的临床病理特征分析  

Clinicopathological features of superficial lymphadenopathy caused by infectious diseases in HIV infection/AIDS patients

作　　者：林静 张晨[2] 董宇杰[2] 刘子臣[2] 李琨 车南颖[2] LIN Jing;ZHANG Chen;DONG Yu-jie;LIU Zi-chen;LI Kun;CHE Nan-ying(Department of Pathology,Guangxi Zhuang Autonomous Region Longtan Hospital,Liuzhou 545005,China)

机构地区：[1]广西壮族自治区龙潭医院病理科,柳州545005 [2]首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所病理科耐药结核病研究北京市重点实验室

出　　处：《中国防痨杂志》2021年第3期268-273,共6页Chinese Journal of Antituberculosis

基　　金：国家自然科学基金(82072381);北京市科技计划医药协同科技创新研究(Z181100001918027);北京市科委首都临床诊疗技术研究及示范应用项目(Z191100006619079);北京市医院管理中心“青苗”计划专项经费(QML20191601);通州区高层次人才发展支持计划(YHLD2018006、YHLD2019036)。

摘　　要：目的探讨HIV感染/AIDS患者感染性浅表淋巴结病组织病理学特征、致病病原体形态学特点和分布部位。方法回顾性分析2018年1月至2019年6月广西壮族自治区龙潭医院收治的,经组织病理学明确诊断为浅表性淋巴结感染性疾病的88例HIV感染/AIDS患者的淋巴结活检组织病理学特点,并对其标本进一步行抗酸染色、过碘酸雪夫(periodic acid schiff,PAS)染色及六胺银染色查找病原体,应用荧光定量PCR技术检测MTB DNA和荧光定量PCR熔解曲线法进行分枝杆菌菌种鉴定。结果88例患者淋巴结活检组织病理学诊断结果为MTB感染50例(56.8%)、马尔尼菲蓝状菌(Talaromyces marneffei,TM)感染32例(36.4%)、非结核分枝杆菌(nontuberculous mycobacterium,NTM)感染3例(3.4%)、MTB并发TM感染2例(2.3%)、隐球菌感染1例(1.1%)。其中苏木精-伊红(hematoxylin-eosin,HE)染色条件下,不同病原体感染的88例患者可有相同组织病理学表现,如23例(26.1%)MTB、TM、MTB并发TM、隐球菌感染患者可共同表现为典型肉芽肿伴坏死,19例(21.6%)MTB、MTB并发TM、TM感染患者可共同表现为不典型肉芽肿伴坏死;38例(69.1%,38/55)分枝杆菌感染患者可经抗酸染色找到分枝杆菌,34例TM和1例隐球菌感染患者可经PAS染色和六胺银染色找到真菌;分子病理检测MTB DNA阳性52例,菌种鉴定NTM感染3例。结论HIV感染/AIDS患者感染性浅表淋巴结病的组织病理学形态表现多样,不具有特异性,特殊染色和分子检测技术可提高确诊率。Objective To explore the clinicopathological features,morphological characteristics and distribution patterns of pathogens in HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases.Methods Eighty-eight HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases were retrospectively recruited between January 2018 and June 2019 from Guangxi Zhuang Autonomous Region Longtan Hospital,and the clinicopathological features were analyzed.These biopsy specimens of lymph nodes were examined with acid-fast staining,periodic acid-schiff(PAS)staining,Giemsa staining,taqman fluorescent quantitative PCR and fluorescence PCR melting curve method.Results Pathological diagnosis confirmed 50 cases of tuberculosis(TB),36 cases of talaromycosis caused by talaromyces marneffei(TM)infection,3 cases of nontuberculous mycobacterial diseases(NTM),2 cases of co-infection of TB and TM,and one case of cryptococcus.These different infectious diseases showed similar histopathological manifestations with HE(hematoxylin-eosin,HE)staining.For example,23 cases(26.1%)with TB,TM,TB complicated with TM and cryptococcus showed typical necrotizing granulomas,and 19 cases(21.6%)with TB,TB complicated with TM and TM showed atypical necrotizing granulomas.Special staining showed that acid-fast bacilli were detected in 38 cases(69.1%,38/55)of mycobacterial infection,and fungus were found in 34 cases of TM and 1 case of cryptococcus by PAS and Giemsa staining.The results of molecular pathology showed that 52 cases were TB and 3 cases were NTM.Conclusion The histopathological features of HIV infection/AIDS patients with superficial lymphadenopathy caused by infectious diseases are atypical.Special staining and molecular pathological techniques are useful in improving diagnostic accuracy.

关 键 词：HIV感染 淋巴结炎 活组织检查 病理学 临床 诊断技术和方法 

分 类 号：R512.91[医药卫生—内科学] R551.2[医药卫生—临床医学]