3种方法检测艾滋病患者血和脑脊液中隐球菌的结果分析

中国真菌学杂志　 2018, Vol. 13 　Issue (6): 340-344.

3种方法检测艾滋病患者血和脑脊液中隐球菌的结果分析

曹宇硕¹, 钱雪琴¹, 蔡金凤¹, 陈智瑾¹, 赵洋洋¹, 朱召芹¹, 卢洪洲²

1. 上海市公共卫生临床中心检验医学科;
2. 上海市公共卫生临床中心感染与免疫科, 上海 201508

收稿日期:2018-04-11 出版日期:2018-12-28 发布日期:2018-12-28
通讯作者: 卢洪洲,E-mail:luhongzhou@fudan.edu.cn E-mail:luhongzhou@fudan.edu.cn
作者简介:曹宇硕,女(汉族),本科,检验技师.E-mail:caoyushuo0812@126.com
基金资助:
国家"十三五"重大新药创制专项（2017ZX09304027）

Analysis of three methods for detecting Cryptococcus in blood and cerebrospinal fluid of AIDS patients

CAO Yu-shuo¹, QIAN Xue-qin¹, CAI Jin-feng¹, CHEN Zhi-jin¹, ZHAO Yang-yang¹, ZHU Zhao-qin¹, LU Hong-zhou²

Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Department of infection and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508

Received:2018-04-11 Online:2018-12-28 Published:2018-12-28

摘要/Abstract

摘要：

目的比较真菌培养、墨汁染色、侧向免疫层析法（LFA）检测艾滋病患者脑脊液和血标本中隐球菌的阳性率差异，以期为临床医生提供隐球菌感染理想的检测方法。方法采用回顾性分析，收集2017年本院就诊的1 049例AIDS患者的血液和脑脊液标本，进行真菌培养、侧向免疫层析法和脑脊液墨汁染色。数据分析应用SPSS 14.0软件。结果 1 049例AIDS患者，其血培养、隐球菌抗原检测、脑脊液培养和墨汁染色阳性率分别为2.8%（19/688）、10.96%（115/1 049）、9.18%（29/316）、17.99%（59/328），其中201例患者同时做了脑脊液和血标本的隐球菌抗原检测，阳性率分别为27.86%和37.31%，差异有统计学意义（P<0.05）。292例AIDS患者同时做了脑脊液的墨汁染色和隐球菌抗原检测，阳性率分别为19.52%和23.97%，隐球菌抗原检测的阳性率大于墨汁染色法，差异无统计学意义（P>0.05）。结论 3种方法检测结果显示侧向免疫层析法阳性率最高，比较脑脊液和血标本侧向免疫层析法阳性率，血标本阳性率较高，所以血标本侧向免疫层析法检测是诊断AIDS是否合并隐球菌感染的理想方法之一。

关键词: 艾滋病, 新生隐球菌, 侧向免疫层析法, 墨汁染色, 培养

Abstract:

Objective To compare the positive rates of Cryptococcus in blood and cerebrospinal fluid (CSF) specimens of patients with HIV/AIDS by the methods of fungal culture, ink staining and Lateral immunochromatography(LFA), hoping to provide a reference for clinicians to diagnose the HIV/AIDS combined with Cryptococcus infection. Methods Totally 1 049 blood and CSF specimens of patients with HIV/AIDS in 2017 were collected for detection by the methods of fungal culture, ink staining and LFA. Besides, CSF specimens were stained with ink. SPSS software (version 14.0) was used for data analysis. Results The positive rates of blood culture, LFA, CSF culture and ink staining for 1 049 patients with HIV/AIDS were 2.8% (19/688), 10.96% (115/1049), 9.18% (29/316), 17.99% (59/328), respectively. 201 patients were both tested by LFA in cerebrospinal fluid and blood at the same time, that positive rates were 27.86% and 37.31%, respectively, with a significant difference statistically (P<0.05). 292 patients with HIV/AIDS were examined by ink staining and LFA in cerebrospinal fluid, that positive rates were 19.52% and 23.97%, respectively, with no significant difference statistically (P>0.05). Conclusion The results of three methods showed that the positive rate of LFA was the highest. Compared with the positive rate of LFA in cerebrospinal fluid, the positive rate of blood samples was higher. So LFA is one ideal method for diagnosis of AIDS complicated with Cryptococcus infection.

Key words: HIV/AIDS, Cryptococcus neoformans, lateral immunochromatography, ink stain, culture

中图分类号:

R446.5

曹宇硕, 钱雪琴, 蔡金凤, 陈智瑾, 赵洋洋, 朱召芹, 卢洪洲. 3种方法检测艾滋病患者血和脑脊液中隐球菌的结果分析[J]. 中国真菌学杂志, 2018, 13(6): 340-344.

CAO Yu-shuo, QIAN Xue-qin, CAI Jin-feng, CHEN Zhi-jin, ZHAO Yang-yang, ZHU Zhao-qin, LU Hong-zhou. Analysis of three methods for detecting Cryptococcus in blood and cerebrospinal fluid of AIDS patients[J]. Chinese Journal of Mycology, 2018, 13(6): 340-344.

参考文献

[1] 魏艳艳,邹桂舟,叶珺,等.艾滋病合并机会性感染104例临床分析[J].安徽医药,2016,20(4):679-682.
[2] Kaplan JE, Benson C, Holmes KK, et al.Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents:recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America[J].MMWR Recomm Rep,2009,58(RR-4):1-207.
[3] 周晓冬,钱宏波,于智君,等. 中枢神经系统感染患者的脑脊液检测结果分析[J]. 海南医学,2016,27(20):3313-3315.
[4] Vidal JE, Boulware DR. Lateral flow assay for cryptococcal antigen:an important advance to improve the continuum of HIV care and reduce cryptococcal meningitis-related mortality[J]. Rev Inst Med Trop Sao Paulo, 2015, 57(19):38-45.
[5] 樊新红,王丽,崔长富,等.脑脊液阿立新兰染色在隐球菌脑膜炎诊断中的价值[J].吉林医学,2014,35(20):4484-4485.
[6] 吴开进.艾滋病患者血培养菌型分布及其耐药性[J].热带医学杂志,2017,17(10):1311-1313.
[7] 金亮,沈定霞.格特隐球菌感染的临床特征与实验室研究进展[J].检验医学,2017,32(11):1065-1069.
[8] Vijayan T, Chiller T, Klausner JD. Sensitivity and specificity of a new cryptococcal antigen lateral flow assay in serum and cerebrospinal fluid[J]. MLO Med Lab Obs, 2013,45(3):16-20.
[9] Cáceres DH, Zuluaga A, Tabares AM, et al. Evaluation of a cryptococcal antigen lateral flow assay in serum and cerebrospinal fluid for rapid diagnosis of cryptococcosis in Colombia[J]. Rev Inst Med Trop Sao Paulo, 2017, 59:e76.
[10] Williams DA, Kiiza T, Kwizera R,et al. Evaluation of fingerstick cryptococcal antigen lateral flow assay in HIV-infected persons:a diagnostic accuracy study[J]. Clin Infect Dis, 2015, 61(3):464-467.
[11] 刘源,付锦.隐球菌性脑膜脑炎诊断与治疗进展[J].脑与神经疾病杂志,2016,24(12):789-792.

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