骨髓活检在人类免疫缺陷病毒感染患者发热性疾病快速诊断中的应用
Utility of bone marrow biopsy for rapid diagnosis of febrile illnesses in patients with human immunodeficiency virus infection.
作者信息
Luther J M, Lakey D L, Larson R S, Kallianpur A R, D'Agata E, Cousar J B, Haas D W
机构信息
Department of Medicine, Vanderbilt University Medical Center and the Nashville Veterans Administration Medical Center, Tenn 37212, USA.
出版信息
South Med J. 2000 Jul;93(7):692-7.
BACKGROUND
Histochemical staining of bone marrow biopsy samples for microorganisms may provide a presumptive diagnosis weeks before culture.
METHODS
To identify predictors of histochemical positivity, we reviewed 161 bone marrow biopsies from febrile patients with human immunodeficiency virus (HIV) infection.
RESULTS
By multivariate analysis, both hematocrit value <30% and white blood cell count <4,000/mm3 predicted biopsy positivity by culture or staining, but only anemia predicted histochemical stain positivity. Of cases with serum lactate dehydrogenase (LDH) levels >600 U/L, histoplasmosis was diagnosed in 31.6% versus 7.8% with lower LDH levels. Among histoplasmosis cases, staining showed fungi in all, with LDH levels >600 U/L versus 44.4% with lower levels.
CONCLUSIONS
Bone marrow biopsy will most likely provide a rapid diagnosis in patients with anemia. Markedly elevated LDH levels suggest stain positivity for Histoplasma capsulatum. Histopathologic patterns may also guide empiric therapy.
背景
对骨髓活检样本进行微生物组织化学染色可能在培养前数周提供初步诊断。
方法
为了确定组织化学阳性的预测因素，我们回顾了161例人类免疫缺陷病毒（HIV）感染发热患者的骨髓活检情况。
结果
通过多变量分析，血细胞比容值<30%和白细胞计数<4000/mm³可预测培养或染色活检阳性，但只有贫血可预测组织化学染色阳性。血清乳酸脱氢酶（LDH）水平>600 U/L的病例中，31.6%被诊断为组织胞浆菌病，而LDH水平较低的病例中这一比例为7.8%。在组织胞浆菌病病例中，所有LDH水平>600 U/L的病例染色均显示有真菌，而LDH水平较低的病例中这一比例为44.4%。
结论
骨髓活检很可能为贫血患者提供快速诊断。显著升高的LDH水平提示荚膜组织胞浆菌染色阳性。组织病理学模式也可指导经验性治疗。
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