艾滋病相关的机会性感染性疾病的临床病理特征
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摘要
目的:探讨艾滋病(AIDS)相关的机会性感染性疾病中的特异性病原体种类、感染部位及感染的临床病理特征。方法:回顾分析我院2013-2017年临床确诊为AIDS患者的病理活检组织标本3258例,使用HE染色、特殊染色(包括:六胺银、PAS、抗酸染色、Warthin-Starry银染)、荧光染色以及免疫组化染色检测其中特异性病原体感染的数量、种类、感染部位和感染病变特征。结果:3258例艾滋病患者组织活检标本中检出特异性病原体感染1294例(占39.7%);其中特异性病原体有11类,分别是:分枝杆菌406例(31.4%)、肺孢子菌308例(23.8%)、巨细胞病毒278例(21.5%)、马尔尼菲蓝状菌173例(13.7%)、隐球菌103例(8.0%)、白色假丝酵母菌16例(1.2%)、毛霉菌2例(0.15%)、曲霉菌及组织胞浆菌各1例(分别0.08%)、弓形虫及梅毒螺旋体各3例(分别0.23%)。感染部位累及全身11个器官(肺、淋巴结、肠、鼻、食管、胃、皮肤、肝、脑、骨与软组织、涎腺),其中以肺(877例)、淋巴结(176例)、肠(159例)最常见。2-3种病原体混合感染115例,混合方式有十余种。结论:AIDS患者的机会性感染病原体种类繁多,常发生混合性感染及播散性感染; AIDS的感染性病变复杂,识别病原体是关键; AIDS相关感染性病变仅一部分具有病原特异性,如病毒包涵体、结核结节和干酪样坏死、真菌菌丝等,有诊断价值。采用多种检测技术明确病因:应结合HE染色提供的线索,利用特殊染色、荧光染色,免疫组化等技术,寻找病原体确定病因。
Objective: To investigate the specific pathogens,infection sites and clinicopathological features of opportunistic infectious diseases related to acquired immune deficiency syndrome( AIDS). Methods: The clinical data of 3258 pathological biopsy specimens from patients,who were clinically diagnosed with AIDS in our hospital between 2013 and 2017,were retrospectively analyzed. HE staining,special staining( including Gomori's methenamine silver staining,PAS,acid-fast staining,and Warthin-Starry silver staining),fluorescent staining and immunohistochemical staining were used to determine the number,type,site and pathological features of specific pathogen infections. Results: A total of 1294 cases( 39.7%) of specific pathogen infections were detected in 3258 pathological biopsy specimens of AIDS patients. Among them,there were 11 specific pathogens,including 406 of Mycobacterium( 31.4%),308 of Pneumocystis( 23.8%),278 of Cytomegalovirus( 21.5%),173 of Brucella marneffei( 13. 7%),103 of Cryptococcus( 8. 0%) and 16 of Candida albicans( 1.2%),2 of Mucor( 0.15%),1 of Aspergillus( 0.08%),1 of Histoplasma( 0.08%),3 of Toxoplasma gondii( 0. 23%) and 3 of Treponema pallidum( 0. 23%). Eleven organs( lung,lymph node,intestine,nose,esophagus,stomach,skin,liver,brain,bone and soft tissues,salivary gland) were involved in the infection sites,among which lung( n = 877),lymph node( n = 176) and intestine( n = 159) were the most common.There were 115 cases of mixed infection of 2-3 pathogens,with more than ten kinds of mixed infections.Conclusion: There are many kinds of opportunistic infectious pathogens in AIDS patients,and the mixed infections and disseminated infections frequently occur. The infectious lesions of AIDS are complex,and the identification of pathogens is the key. Only a part of AIDS-related infectious lesions are pathogen-specific,such as viral inclusion bodies,tuberculosis nodules,caseous necrosis and fungal hyphae,which are of diagnostic value. Multiple detection techniques are used to identify the etiology. It is necessary to combine the clues provided by HE staining,and use special staining,fluorescent staining,immunohistochemistry and other techniques to identify the etiology of pathogens.
Objective: To investigate the specific pathogens,infection sites and clinicopathological features of opportunistic infectious diseases related to acquired immune deficiency syndrome( AIDS). Methods: The clinical data of 3258 pathological biopsy specimens from patients,who were clinically diagnosed with AIDS in our hospital between 2013 and 2017,were retrospectively analyzed. HE staining,special staining( including Gomori's methenamine silver staining,PAS,acid-fast staining,and Warthin-Starry silver staining),fluorescent staining and immunohistochemical staining were used to determine the number,type,site and pathological features of specific pathogen infections. Results: A total of 1294 cases( 39.7%) of specific pathogen infections were detected in 3258 pathological biopsy specimens of AIDS patients. Among them,there were 11 specific pathogens,including 406 of Mycobacterium( 31.4%),308 of Pneumocystis( 23.8%),278 of Cytomegalovirus( 21.5%),173 of Brucella marneffei( 13. 7%),103 of Cryptococcus( 8. 0%) and 16 of Candida albicans( 1.2%),2 of Mucor( 0.15%),1 of Aspergillus( 0.08%),1 of Histoplasma( 0.08%),3 of Toxoplasma gondii( 0. 23%) and 3 of Treponema pallidum( 0. 23%). Eleven organs( lung,lymph node,intestine,nose,esophagus,stomach,skin,liver,brain,bone and soft tissues,salivary gland) were involved in the infection sites,among which lung( n = 877),lymph node( n = 176) and intestine( n = 159) were the most common.There were 115 cases of mixed infection of 2-3 pathogens,with more than ten kinds of mixed infections.Conclusion: There are many kinds of opportunistic infectious pathogens in AIDS patients,and the mixed infections and disseminated infections frequently occur. The infectious lesions of AIDS are complex,and the identification of pathogens is the key. Only a part of AIDS-related infectious lesions are pathogen-specific,such as viral inclusion bodies,tuberculosis nodules,caseous necrosis and fungal hyphae,which are of diagnostic value. Multiple detection techniques are used to identify the etiology. It is necessary to combine the clues provided by HE staining,and use special staining,fluorescent staining,immunohistochemistry and other techniques to identify the etiology of pathogens.
引文
[1]刘德纯.艾滋病临床病理学[M].合肥,安徽科学技术出版社,2002.
[2]Gill J,May M,Lewden C.Causes of death in HIV-1-infected patients treated with antiretroviraltherapy,1996-2006:Collaborative analysis of 13 HINcohort studies[J]. Clin Infect Dis,2010,50(10):1387-1396.
[3]Palladino C,Climent FJ,Jose MI,et al.Causes of death in pediatric patients vertically infected by the human immunodeficiency virus type 1 in Madrid Spain,from 1982to mid-2009[J]. Pediatr Infect Dis J,2011,30(6):495-550.
[4]George MD,Reay E,Sankaran S,et al. Early antiretroviral therapy for simian immunodeficiency virus infection leads to mucosal CD4+T-cell restoration and enhanced gene expression regulating mucosal repair and regeneration[J].J Virol,2005,79(5):2709-2719.
[5]肖艳华,肖冠英,陈谐捷,等.艾滋病合并肺部感染患者支气管镜活检组织的病理学特征[J].临床与实验病理学杂志,2017,33(5):568-570.
[6]李凌华,唐小平,邓西龙,等.艾滋病合并肺孢子菌肺炎69例临床分析[J].中华传染病杂志,2008,26(12):739-743.
[7]曾静,刘雪梅,画伟,等.艾滋病肺部机会性感染[J].中国医药导报,2018,15(4):31-34.
[8]杨小霞,高世成.艾滋病患者合并巨细胞病毒感染的临床特点及危险因素分析[J].中华临床感染病杂志,2017,10(1):26-30.
[9]Katano H,Hishima T,Mochizuki M,et al. The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan[J].BMC Infect Dis,2014,14:229.
[10]张路坤,王辉,孙丽琴,等.431例HIV/AIDS患者巨细胞病毒感染情况的调查分析[J].中华实验和临床感染病杂志(电子版),2013,7(2):214-218
[11] Werneck-SilvaAL,PradoIB. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiencyvirus-infected patients[J]. World J Gastroenterol,2009,15(9):1050-1056.
[12]郑叶,曾东,童海涛,等.特殊染色技术在艾滋病合并真菌病理诊断中的应用[J].中华临床感染学杂志,2014,7(3):207-211.
[13]夏彬彬,张莉,李倩,等.艾滋病合并弓形虫感染研究进展[J].现代预防医学,2015,42(18):3417-3419.
[14]常晓,张海萍,连石.HIV合并梅毒螺旋体感染的研究进展[J].中国艾滋病性病,2009,15(5):553-555.=
[2]Gill J,May M,Lewden C.Causes of death in HIV-1-infected patients treated with antiretroviraltherapy,1996-2006:Collaborative analysis of 13 HINcohort studies[J]. Clin Infect Dis,2010,50(10):1387-1396.
[3]Palladino C,Climent FJ,Jose MI,et al.Causes of death in pediatric patients vertically infected by the human immunodeficiency virus type 1 in Madrid Spain,from 1982to mid-2009[J]. Pediatr Infect Dis J,2011,30(6):495-550.
[4]George MD,Reay E,Sankaran S,et al. Early antiretroviral therapy for simian immunodeficiency virus infection leads to mucosal CD4+T-cell restoration and enhanced gene expression regulating mucosal repair and regeneration[J].J Virol,2005,79(5):2709-2719.
[5]肖艳华,肖冠英,陈谐捷,等.艾滋病合并肺部感染患者支气管镜活检组织的病理学特征[J].临床与实验病理学杂志,2017,33(5):568-570.
[6]李凌华,唐小平,邓西龙,等.艾滋病合并肺孢子菌肺炎69例临床分析[J].中华传染病杂志,2008,26(12):739-743.
[7]曾静,刘雪梅,画伟,等.艾滋病肺部机会性感染[J].中国医药导报,2018,15(4):31-34.
[8]杨小霞,高世成.艾滋病患者合并巨细胞病毒感染的临床特点及危险因素分析[J].中华临床感染病杂志,2017,10(1):26-30.
[9]Katano H,Hishima T,Mochizuki M,et al. The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan[J].BMC Infect Dis,2014,14:229.
[10]张路坤,王辉,孙丽琴,等.431例HIV/AIDS患者巨细胞病毒感染情况的调查分析[J].中华实验和临床感染病杂志(电子版),2013,7(2):214-218
[11] Werneck-SilvaAL,PradoIB. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiencyvirus-infected patients[J]. World J Gastroenterol,2009,15(9):1050-1056.
[12]郑叶,曾东,童海涛,等.特殊染色技术在艾滋病合并真菌病理诊断中的应用[J].中华临床感染学杂志,2014,7(3):207-211.
[13]夏彬彬,张莉,李倩,等.艾滋病合并弓形虫感染研究进展[J].现代预防医学,2015,42(18):3417-3419.
[14]常晓,张海萍,连石.HIV合并梅毒螺旋体感染的研究进展[J].中国艾滋病性病,2009,15(5):553-555.=