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组织病理学诊断的肺真菌病187例菌种分布的回顾性分析

The spectrum of pathogens in 187 cases of pulmonary fungal disease diagnosed by histopathology-a retrospective analysis

摘要:

目的:探讨病理学诊断的肺真菌病的菌种分布。方法:回顾性分析2001—2015年北京协和医院病理科送检组织标本特殊染色病理诊断肺真菌病的患者187例(包括肺切除或开胸肺活检92例,经皮肺穿刺33例,经支气管镜活检62例),所有病例除常规HE外,均行六胺银、PAS、黏液卡红及抗酸染色;查阅临床病历资料及真菌培养情况并进行分析。结果:187例患者,男103例,女84例;年龄12~70岁,平均(48±14)岁。组织病理诊断的菌种为:肺曲霉病85例(45.5%),其中侵袭性曲霉感染60例,曲霉球25例;肺隐球菌病51例(27.3%),肺毛霉6例(3.2%),肺组织胞浆菌病3例(1.6%),肺念珠菌病3例(1.6%),肺孢子菌病2例(1.1%),由于组织少、退变等限制性原因导致镜下不能明确分类的真菌病37例(19.8%);2011—2015年88例组织病理学诊断为真菌病的患者中,35例送真菌培养,送检率为39.9%;培养结果与病理诊断一致的18例(51.4%),病理诊断为真菌病但未培养出真菌的13例(37.1%),病理未能明确分类但培养出真菌的3例(8.6%)。结论:经组织标本病理诊断的肺真菌病中,肺曲霉病最多见,其他依次为肺隐球菌病、肺毛霉病、肺组织胞浆菌病、肺念珠菌病及肺孢子菌病。少部分病例组织化学特殊染色不能分类;病理组织化学特殊染色与培养对常见真菌菌种分型的符合率较高。约37%经病理组织确认的肺真菌病病例培养阴性。临床工作中,应重视组织化学特殊染色在真菌感染诊断中的作用。

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abstracts:

Objective:To investigate the spectrum of pathogens causing lung fungal disease diagnosed by histopathology through histochemical special staining, compared to the fungal culture results, and to further evaluate the diagnostic value of histochemical special staining in pulmonary fungal disease.Methods:We performed a retrospective analysis of 187 cases of pulmonary fungal disease diagnosed by histopathology in Peking Union Medical College Hospital from 2001 to 2015 (including 92 cases with pulmonary resection or open lung biopsy, 33 with percutaneous lung biopsy and 62 ones with fiberoptic bronchoscopic lung biopsy). All cases were treated with hexamine silver, PAS, mucus carmine and acid-fast staining in addition to conventional HE staining. The clinical records and the fungal culture results were reviewed.Results:There were 103 male and 84 female patients, aged from 12 to 70 years [average (48±14) years]. There were 85 cases(45.5%) of pulmonary aspergillosis(including 60 cases of invasive infection and 25 cases of aspergilloma), 51 cases(27.3%) of pulmonary cryptococosis, 6 cases (3.2%)of pulmonary mucormycosis, 3 cases(1.6%) of pulmonary histoplasmosis, 3 cases (1.6%)of pulmonary candidiasis, and 2 cases (1.1%) of pneumocystosis ,while in the remaining 37 cases (19.8%) the pathogens could not be clearly classified by microscopy due to limited tissue or degeneration. Among the 88 patients with pulmonary fungal disease diagnosed by histopathology from 2011 to 2015, 35 ones (39.9%) were detected by fungal culture (including lung biopsy, intraoperative swab, blood, bronchoalveolar lavage fluid and sputum, etc.). The diagnostic results of 18 cases were completely consistent between histopathological examination and fungal culture (18/35, 51.4%), while 13 cases (13/35, 37.1%) were diagnosed by histopathology but no fungi were cultured, and in 3 cases (3/35,8.6%) the culture was positive for fungi which could not be classified clearly by histopathology. In another case the pathogen was found to be Cryptococcus histopathologically but the lavage culture grew“candida”, but the patient′s blood cryptococcal antigen was positive. Conclusions:Among patients with histopathological diagnosis of pulmonary fungal disease, pulmonary aspergillosis was the most common, followed by pulmonary cryptococcosis, pulmonary mucormycosis, pulmonary histoplasmosis, pulmonary candidiasis and pneumocystosis. A small number of cases could not be classified by histopathology through histochemical special staining. There was a high consistency in discovering fungal pathogens between pathological histochemical special staining and culture method, but 37% pulmonary fungal disease diagnosed by histopathology were culture negative. In practice, the role of histochemical special staining in diagnosing pulmonary fungal disease should be paid more attention.

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