痰涂片检出白细胞吞噬细菌在下呼吸道感染诊断中的价值

Role of leukocyte phagocytosis bacterium in sputum smear specimens for the diagnosis of lower respiratory tract infection

目的探讨痰涂片检出白细胞(WBC)吞噬细菌在下呼吸道感染诊断中的应用价值。方法随机收集175例住院患者的合格痰标本,通过直接涂片革兰染色观察WBC和细菌之间的免疫病理现象(吞噬或伴行),进行细菌培养鉴定及药物敏感性试验,收集患者临床资料,统计分析痰涂片结果与患者临床情况、培养一致性对于鉴别致病菌和定植菌的辅助诊断作用。结果 175例患者中,56.6%年龄在70岁以上,85.1%具有一定的感染症状,而91.4%在留取痰标本之前接受过抗菌治疗,痰涂片可见WBC吞噬或伴行细菌的标本51例(30%),与细菌培养结果的一致性(84.3%)显著高于未见WBC吞噬或伴行细菌的标本(58.1%,P<0.05),且对致病菌的鉴别率(92.2%)也明显高于未见WBC吞噬或伴行细菌的标本(38.7%,P<0.05)。结论痰涂片检出WBC吞噬或伴行细菌在下呼吸道感染诊断中具有重要价值,可在临床实验室推广。

Objective To investigate the role of leukocyte phagocytosis bacterium in sputum smear specimens for the diagnosis of lower respiratory tract infection. Methods A total of 175 sputum smear specimens were collected. Immune pathological（phagocytosis or accompanying）between leukocyte and bacterium was observed through the smear with Gram stain directly. Bacterial culturing and drug susceptibility were performed. The patients＇ clinical data were collected. The consistency was evaluated to distinguish pathogenic bacterium colonization bacterium.Results Among the 175 cases,56.6% cases were above 70 years old,85.1% cases had infection,91.4% cases received antibiotic treatment before specimen collecting. There were 51 specimens（30%） with the phenomenon of bacterial phagocytosis or accompanying by leucocytes. The consistency with the results of culturing（84.3%） was higher than those without the phenomenon of bacterial phagocytosis or accompanying by leucocytes（58.1%,P〈0.05）,and the diagnosis rate of pathogenic bacteria was higher as well （92.2% and 38.7%,P〈0.05）. Conclusions Bacterial phagocytosis or accompanying by leucocytes in sputum smear specimens plays a role for the diagnosis of lower respiratory tract infection.