论文部分内容阅读
目的探索痰细胞学涂片检菌对ICU肺部真菌感染诊断意义。方法 38例76份痰标本在常规痰培养后,对剩余标本应用4倍体积的0.4%二硫苏糖醇进行液化,再行密度梯度离心,分离出痰中的细胞成分,对其进行涂片和革兰染色,观察涂片中细胞周围黏附有真菌菌丝及孢子的标本,以患者G试验阳性同时痰培养培养出真菌为标准,与其进行比较,分析其对ICU肺部真菌感染定性诊断的准确性;并对同一患者两种方法连续2次结果的一致性进行统计学分析。结果 76份痰标本中真菌培养阳性17份,其中15份G试验阳性,4例患者2次标本培养结果一致(8份),单次标本真菌培养阳性9份,59份无真菌生长;细胞学涂片检菌结果:有19份标本(在8例患者和3份单一标本)涂片中发现较多真菌菌丝及孢子黏附于细胞的表现;与标准相比总准确率为86.67%,经一致性检验,kappa=0.785,两者没有显著性差异;在同一患者2个标本的一致性方面,细胞学涂片检菌方法:19份标本,16份是一致的,而常规真菌培养方法17份标本只有8份相一致,经卡方检验?2=4.09,P<0.05,有明显统计学意义。结论痰细胞学涂片检菌对ICU肺部真菌感染能够准确地做出早期定性诊断。
Objective To explore the diagnostic significance of sputum cytology smears on pulmonary fungal infection in ICU. Methods Totally 76 sputum specimens of 38 patients were cultured in conventional sputum culture, and the remaining samples were liquefied with 4 times volume of 0.4% dithiothreitol, followed by density gradient centrifugation to separate the sputum cell components and smear them And Gram stain to observe the smear in the cell adhesion around the fungal mycelium and spores specimens to patients with positive G test sputum culture fungi as the standard, compared with their analysis of ICU pulmonary fungal infection qualitative diagnosis Accuracy; and two patients in the same method two consecutive results of consistency for statistical analysis. Results Sixteen sputum specimens were positive for fungal culture, of which 15 were positive for G test. The results of two specimens from four patients were consistent (8 specimens). Nine specimens were positive for fungal culture and 59 specimens were fungal-free. Cytology Pap smear results: In 19 smears (in 8 patients and 3 single specimens) smear found more fungal mycelium and spore adhesion to the cell performance; compared with the standard total accuracy of 86.67%, by Consistency test, kappa = 0.785, no significant difference between the two; in the same patient two specimens consistency, cytology smear method: 19 specimens, 16 are consistent, and conventional fungal culture method 17 Only 8 samples were consistent, the chi-square test? 2 = 4.09, P <0.05, statistically significant. Conclusion Sputum cytology smear bacteria in ICU lung fungal infection can accurately make an early qualitative diagnosis.