CAJ | 학술논문

目的探讨我国现有文献中报道的蠊缨滴虫肺部感染是否被误判,蠊缨滴虫是否为引起肺部感染的致病原.方法对2012年6月至2013年5月北京大学人民医院诊治的6例肺部疾病患者BALF中发现的顶端带有纤毛的活细胞的活动状态、光镜特点及电镜下的超微结构进行研究,鉴定其来源和性质,确定是否为蠊缨滴虫,同时进行文献检索.以“蠊缨滴虫”和“Lophomonas blattarum”为关键词,在万方数据库、中国知识资源总库和PubMed数据库中检索相关文献,复习文献中提供的细胞图片及诊断方法,确定文献中肺蠊缨滴虫感染的诊断是否正确.结果 6例患者BALF 中发现的活细胞,在光镜及电镜下观察均表现为气道纤毛上皮细胞的特点,细胞核位于细胞的基底部,且不具有蠊缨滴虫特有的结构(萼器、核周小管、轴丝).文献报道的蠊缨滴虫感染病例均依据细胞的活动性及具有纤毛的特点进行诊断,未对照文献报道的“蠊缨滴虫”的形态和结构进行超微结构研究.所有发表文献中的细胞染色图片与本研究发现的上皮细胞形态基本一致.结论在过去的20年中,我国报道的有关“蠊缨滴虫”肺部感染的病例均为误诊,目前尚不能确定蠊缨滴虫为引起肺部感染的致病原.
목적 탐토아국현유문헌중보도적렴영적충폐부감염시부피오판,렴영적충시부위인기폐부감염적치병원.방법 대2012년6월지2013년5월북경대학인민의원진치적6례폐부질병환자BALF중발현적정단대유섬모적활세포적활동상태、광경특점급전경하적초미결구진행연구,감정기래원화성질,학정시부위렴영적충,동시진행문헌검색.이“렴영적충”화“Lophomonas blattarum”위관건사,재만방수거고、중국지식자원총고화PubMed수거고중검색상관문헌,복습문헌중제공적세포도편급진단방법,학정문헌중폐렴영적충감염적진단시부정학.결과 6례환자BALF 중발현적활세포,재광경급전경하관찰균표현위기도섬모상피세포적특점,세포핵위우세포적기저부,차불구유렴영적충특유적결구(악기、핵주소관、축사).문헌보도적렴영적충감염병례균의거세포적활동성급구유섬모적특점진행진단,미대조문헌보도적“렴영적충”적형태화결구진행초미결구연구.소유발표문헌중적세포염색도편여본연구발현적상피세포형태기본일치.결론 재과거적20년중,아국보도적유관“렴영적충”폐부감염적병례균위오진,목전상불능학정렴영적충위인기폐부감염적치병원.
Objective To validate the authenticity of the cases diagnosed as pulmonary Lophomonas blattarum infection in literatures and Lophomonas blattarum as a kind of pathogen resulting in pulmonary infection.Methods From June 2012 to May 2013,mobile cells with cilia at the anterior end of the cells were observed in BALF from 6 patients with pulmonary disease in our hospital.Morphological feature and ultrastructure of the cells were further investigated by optical microscope and electron microscope to determine the type of the cells referring to literature-published photos of Lophomonas blattarum.Literatures about Lophomonas blattarum infection were searched with keyword Lophomonas blattarum from Wanfang Data,China National Knowledge Infrastructure (CNKI) and PubMed.Diagnostic methods and figures provided by the literature were carefully reviewed,and the accuracy of diagnosis of pulmonary Lophomonas blattarum was identified.Results Mobile cells found in BALF from the 6 patients in our hospital had the morphological features of bronchial ciliate epithelial cells.A nucleus far from the cilia was observed in the middle or at the bottom of the cytoplasm,and these cells did not display the characteristic cytological structures of Lophomonas blattarum:calyx,perinuclear tubules and axial filament.Diagnosis of pulmonary Lophomonas blattarum reported in literatures so far were all based on the morphological features of mobile cells with a cluster of flagellate at anterior end of the cell by optical microscopy.None of the authors did further exploration on the ultrastructure of such a kind of cells and compared with features of Lophomonas blattarum described in the literature.All the active cells reported in literatures had the identical morphological features to those found in our investigation.Conclusion In the past 20 years,all the diagnosed cases as pulmonary Lophomonas blattarum infection reported in our country were misdiagnosed.Currently,there is no evidence to show Lophomonas blattarum as a pathogen resulting in pulmonary infection.