支气管肺泡灌洗液中纤毛柱状细胞与蠊缨滴虫甄别的临床研究

A study on the differential diagnosis of ciliated epithelial cells from Lophomonas blattarum in bronchoalveolar lavage fluid

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“Lophomonasblattarum”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。

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 uhrastructure of the ceils were further investigated by optical microscope and electron microscope to determine the type of the cells referring to fiterature-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 uhrastructure 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.