艾滋病合并耶氏肺孢子虫(菌)肺炎的实验室诊断

Laboratory Diagnosis of HIV/AIDS Patients Complicated with Pneumocystis jirovecii Poneumonia

采用吉氏染色法检查艾滋病患者有耶氏肺孢子虫(菌)肺炎临床表现者痰液和支气管肺泡灌洗液(BALF)中的耶氏肺孢子虫(菌)。抽取部分留痰患者(500例)血液,检测CD4+淋巴细胞。结果显示,痰液标本耶氏肺孢子虫(菌)的阳性率(46.8%,845/1 806)显著低于BALF标本(55.8%,106/190)(P<0.05)。耶氏肺孢子虫(菌)阳性患者有临床症状的比例(96.6%,816/845)显著高于阴性者(64.0%,615/961)(P<0.05)。患者血液中CD4+淋巴细胞数量越少,耶氏肺孢子虫(菌)阳性率越高,CD4+细胞数量>200×106/L组、200×106/L～100×106/L组和<100×106/L组的耶氏肺孢子虫(菌)阳性率分别为12.0%(6/50)、39.0%(39/100)和54.6%(191/350)(P<0.05)。吉氏染色法是较好的检查耶氏肺孢子虫(菌)的方法,简单易行,容易推广,但需积累经验。

Pneumocystis jirovecii was detected in sputum samples and bronchoalveolar lavage fluid（BALF） ob-tained from HIV/AIDS patients complicated with Pneumocystis jirovecii poneumonia by Giemsa staining.CD4＋ T lymphocytes of 500 patients were counted by flow cytometer.P.jirovecii positive rate in sputum samples（46.8%,845/1 806） was significantly lower than that of BALF（55.8%,106/190）（P0.05）.The proportion of patients developing clinical symptoms in P.jirovecii positive cases（96.6%,816/845） was higher than that of P.jirovecii negative cases（64.0%,615/961）（P0.05）.P.jirovecii positive rate increased with the decrease of CD4＋ T lymphocyte number.P.jirovecii positive rates in cases with CD4＋ 200×106/L,CD4＋ 200×106/L-100×106/L,and CD4＋ 100×106/L were 12.0%（6/50）,39.0%（39/100）,and 54.6%（191/350）,respectively（P0.05）.Giemsa staining is an efficient,simple and feasible method for P.jirovecii detection,relying on the experience and skill of the operator.