重庆地区HIV阴性免疫力低下患者肺孢子感染率研究分析

Infection rate of pneumocystis in immunocompromised patients without HIV infection in Chongqing

摘要:

目的：探讨重庆地区人类免疫缺陷病毒（human immunodeficiency virus，HIV）阴性免疫力低下患者肺孢子（pneumocys－tis carinii，PC）感染率，为临床上HIV阴性患者合并PC感染的早期诊断及治疗提供生物学依据。方法：取71例HIV阴性免疫力低下患者的痰液标本，分别运用六亚甲基四胺银染色法（gomort methenamine silver stain，GMS）和内转录间隔区（internal tran－scribed spacer，ITS）-巢式PCR法检测标本中肺孢子。结果：71例患者痰液标本中，GMS染色法检测出PC 2例，巢式PCR法检测出PC 25例，差异有统计学意义（ ?字2=21.04，P=0.000）；不同性别患者PC感染率无统计学差异（ ?字2=0.375，P=0.540）；不同年龄阶段患者PC感染率无统计学差异（ ?字2=0.777，P=0.678）。肿瘤放化疗后患者、血液系统疾病患者、肾移植患者、肝移植患者、结缔组织疾病患者感染率分别为33.33%、26.67%、40.00%、42.86%、39.13%，采用Fisher确切概率法对不同病例组感染率进行比较，各病例组间感染率差异无统计学意义（P=0.897），但本组病例PC感染率显著高于同期国外报道，与2009年国内报道感染率相当。结论：重庆地区HIV阴性免疫力低下患者PC感染率较高，临床医师应增强对该类患者是否合并PC感染的警觉性。

Abstract:

Objective：To investigate the infection rate of pneumocystis carinii（PC） in human immunodeficiency virus（HIV） negative immunocompromised patients in Chongqing in order to provide biological references for its early diagnosis and treatment. Methods：Sputum specimens were collected from 71 HIV-negative immunocompromised patients in Chongqing and were detected by Gomori’s methenamine silver stained（GMS） and internal transcribed spacer（ITS）-nested PCR，respectively. Results：PC was detected out in two cases out of 71 cases by GMS and PC was detected out in 25 cases by nested PCR，the difference between the two methods were significant（?字2=21.04，P=0.000） .There was no significant difference in infection rate between difference genders（ ?字2=0.375，P=0.540） and different ages（?字2=0.777，P=0.678）. The infection rates of patients with cancer，heamatolagic disorder，kidney transplantation，liver transplantation and connective tissue disease were 33.33%，26.67%，40.00%，42.86% and 39.13% respectively. There was no signifi－cant difference in infection rates between the different case groups（P=0.897）. The infection rate was significantly higher than that of abroad report and was the same as that of domestic report in 2009. Conclusion：The infection rate of PC of HIV-negative immuno－compromised patients in Chongqing is high. Clinician should enhance the alertness of patients with PC.