AIDS合并隐球菌病的临床病理学分析  

Clinicopathological analysis of AIDS coinfected with cryptococcosis

作　　者：杨坤 孙磊[1] 陈佳敏 张亮[1] 陈香梅 肖江[2] 赵红心[2] 王鹏[1] YANG Kun;SUN Lei;CHEN Jiamin;ZHANG Liang;CHEN Xiangmei;XIAO Jiang;ZHAO Hongxin;WANG Peng(Department of Pathology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Infections Disease Center,Beijing Ditan Hospital,Capital Medical University,Beijing 100015)

机构地区：[1]首都医科大学附属北京地坛医院病理科,北京100015 [2]首都医科大学附属北京地坛医院感染中心,北京100015

出　　处：《中国艾滋病性病》2022年第7期827-830,共4页Chinese Journal of Aids & STD

基　　金：北京市医院管理中心“登峰”人才项目(DFL20191802);北京市医院管理中心临床医学发展专项(ZYLX202126)。

摘　　要：目的 探讨AIDS合并隐球菌病的临床病理特点及细针吸取细胞学技术在其诊断中的应用。方法 对诊断明确的AIDS合并隐球菌病患者,分别进行细针吸取细胞学检查、细胞蜡块制备及活组织检查。细胞学涂片、细胞蜡块及组织学切片分别进行HE染色及特殊染色[过碘酸-雪夫染色(PAS)、六胺银染色(GMS)、抗酸染色],部分病例进行宏基因组学二代测序。同时分析病例的临床表现、实验室检查结果、病理形态学特点等。结果 AIDS合并隐球菌病患者19例,其中男性15例,平均年龄33.8岁(7~54岁)。包括淋巴结细针穿刺吸取细胞学标本12例,脑脊液穿刺细胞学标本4例,肺内占位细针吸取细胞学标本1例,支气管黏膜组织活检1例,皮肤黏膜组织活检1例。最常见的临床症状为发热(17例)、淋巴结肿大(12例)及头痛(12例)。HE染色可见隐球菌菌体呈圆形或椭圆形,有较厚的胶样双层荚膜,可有出芽生长;特殊染色PAS(+),GMS(+)。大部分患者经抗真菌治疗后病情好转。结论 隐球菌在光镜下有独特的形态学表现,活组织检查、细针吸取细胞学结合细胞蜡块及特殊染色可明确诊断。Objective To investigate the clinicopathological characteristics of AIDS coinfected with cryptococcosis and the application the fine needle aspiration cytology technique in its diagnosis.Methods Patients with AIDS coinfeced with cryptococcus were carried on the fine needle aspiration cytology,cell blocks,and biopsy.Hematoxylin-eosin staining and special staining(PAS,GMS,and acid-fast stain) were performed.Moreover,second-generation metagenomics sequencing was performed in some cases.The clinical manifestations,examination results,and pathomorphological features of the cases were analyzed.Results There were 19 patients with AIDS coinfeced with cryptococcosis,including15 males,with an average age of 33.8 years old(7-54 years old).There were 12 cases of lymph node fine-needle aspiration,4 cases of cerebrospinal fluid aspiration,1 case of lung space-occupying fine-needle aspiration,1 case of bronchial mucosa biopsy,and 1 case of skin biopsy.The most common clinical symptoms were fever(17 cases,89.47%),lymph node enlargement(12 cases,63.16%),and headache(12 cases,63.16%).Hematoxylin-eosin staining showed that cryptococcus was round or oval and had a thick colloidal double capsular.They may have bud growth.Special staining PAS(+),GMS(+).Most patients improved after antifungal therapy.Conclusions Cryptococcosis is an opportunistic infection that occurs most often in patients with impaired immune function.Microscopy showed unique patho-morphology,biopsy,and fine-needle aspiration cytology combined with cell blocks and special staining could confirm the diagnosis.

关 键 词：隐球菌病 临床病理学特征 细针吸取细胞学 艾滋病 

分 类 号：R512.91[医药卫生—内科学]