CAJ | 학술논문

目的：探讨骨髓涂片镜检对获得性免疫缺陷综合征（AIDS）合并播散性马尔尼菲青霉（PM）感染的诊断价值。方法对257例AIDS骨髓细胞分析及其骨髓和血液真菌培养结果进行回顾性分析。结果培养法检出PM 74例，涂片镜检检出PM 36例，其中33例与培养结果符合，3例培养阴性但临床支持诊断。以培养结果为标准，骨髓涂片镜检诊断PM感染的特异性为98．4％，敏感性为44．6％。PM侵犯骨髓造血系统的细胞学表现主要见血小板分布减少，组织细胞反应性增生且吞噬活跃，中性粒细胞中毒性改变或发育异常，红系形态异常；PM分布与有核细胞增生度显著相关，增生明显活跃者涂片易见吞噬有PM或/和血细胞的网状细胞及分布于细胞外的PM；增生活跃者网状细胞吞噬活跃但比率不一定增高，细胞内外均较易见PM；增生减低者多见PM散在分布于细胞外，数量少，菌体小，不易找到典型特征；PM的典型特征为菌体分裂前变长，两端钝圆似腊肠，中部有半透明横隔。结论骨髓涂片镜检对AIDS合并播散性PM感染的诊断特异性高，与培养方法联合应用可使近半数患者得到及时治疗，同时也对培养方法的不足进行补充，减少漏检率，可作为AIDS合并PM感染的快速诊断方法。
목적：탐토골수도편경검대획득성면역결함종합정（AIDS）합병파산성마이니비청매（PM）감염적진단개치。방법대257례AIDS골수세포분석급기골수화혈액진균배양결과진행회고성분석。결과배양법검출PM 74례，도편경검검출PM 36례，기중33례여배양결과부합，3례배양음성단림상지지진단。이배양결과위표준，골수도편경검진단PM감염적특이성위98．4％，민감성위44．6％。PM침범골수조혈계통적세포학표현주요견혈소판분포감소，조직세포반응성증생차탄서활약，중성립세포중독성개변혹발육이상，홍계형태이상；PM분포여유핵세포증생도현저상관，증생명현활약자도편역견탄서유PM혹/화혈세포적망상세포급분포우세포외적PM；증생활약자망상세포탄서활약단비솔불일정증고，세포내외균교역견PM；증생감저자다견PM산재분포우세포외，수량소，균체소，불역조도전형특정；PM적전형특정위균체분렬전변장，량단둔원사석장，중부유반투명횡격。결론골수도편경검대AIDS합병파산성PM감염적진단특이성고，여배양방법연합응용가사근반수환자득도급시치료，동시야대배양방법적불족진행보충，감소루검솔，가작위AIDS합병PM감염적쾌속진단방법。
Objective To investigate the bone marrow smear microscopy in the diagnosis of acquired immuno-deficiency syndrome (AIDS)complicated with disseminated Penicillium marneffei(PM).Methods A total of 257 AIDS patients were enrolled.Bone marrow cell analysis and the peripheral blood and bone marrow fungal dimorphic culture were performed,and the results were analyzed retrospectively.Results PM infection was identified in 74 patients by peripheral blood and bone marrow fungal dimorphic culture,and 36 cases were identified as PM infection by bone marrow smear microscopy,among which 3 cases showed negative in fungal dimorphic culture but positive during therapeutic diagnosis.Taking positive fungal dimorphic culture as the standard for PM diagnosis,the specificity of PM by bone marrow smear microscopy was 98.4%,and the sensitivity was 44.6%.The morphology of the bone marrow cell showed that platelet reduced significantly,histiocytosis was reactive,histiocytes were active in phagocytosis,neutrophils developed abnormally or had toxic change,and erythrocytes were morphologically abnormal.The distribution of PM was significantly correlated with the hyperplasia degree of nucleated cell in bone marrow.In the significantly hyperplastic cases,PM were phagocytosed by huge reticulocyte and/or distributed extracellularly.In cases that were hyperplastic, reticulocytes were active in phagocytosis but might not increase,PM could be seen inside or outside of the cells.As for the reduced hyperplastic cases,a small number of PM could be extracellular mainly.The typical characters of PM included sausage shape,elongated cell and a translucent transverse in the middle of the cells before division,and seldom appeared in these cases.Conclusions Bone marrow smear microscopy is a highly specific method for the diagnosis of AIDS complicated with disseminated PM.It could facilitate the therapy on time and,sometimes,make up for the omission from the detection of fungal dimorphic culture.It is suitable for the chinical application of AIDS complicated with disseminated PM.