应用细针穿刺外周神经纯神经炎型麻风患者的标本进行细胞学和 PCR 检测以确诊：一项初步研究。

Use of fine needle aspirate from peripheral nerves of pure-neural leprosy for cytology and PCR to confirm the diagnosis: a pilot study.

机构信息

Department of Dermatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.

出版信息

Indian J Dermatol Venereol Leprol. 2013 Nov-Dec;79(6):789-94. doi: 10.4103/0378-6323.120731.

DOI:10.4103/0378-6323.120731

PMID:24177611

Abstract

BACKGROUND

The diagnosis of pure neural leprosy (PNL) remained subjective because of over-dependence of clinical expertise and a lack of simple yet reliable diagnostic tool. The criteria for diagnosis, proposed by Jardim et al., are not routinely done by clinicians in developing country as it involves invasive nerve biopsy and sophisticated anti-PGL-1 detection. We conducted a study using fine needle aspiration cytology (FNAC) coupled with Ziehl Neelsen staining (ZN staining) and Multiplex-Polymerase Chain Reaction (PCR) specific for M. leprae for an objective diagnosis of pure neural leprosy (PNL), which may be simpler and yet reliable.

AIM

The aim of the study is to couple FNAC with ZN staining and multiplex PCR to diagnose pure neural leprosy patients rapidly, in simpler and yet reliable way.

METHODS

Thirteen patients of PNL as diagnosed by two independent consultants were included as case, and 5 patients other than PNL were taken as control in the study. Fine needle aspiration was done on the affected nerve, and aspirates were evaluated for cytology, ZN staining and multiplex-PCR.

RESULTS

Out of the 13 cases where fine needle aspiration was done, M. leprae could be elicited in the nerve tissue aspirates in 5 cases (38.4%) with the help of conventional acid-fast staining and 11 cases (84.6%) with the help of multiplex PCR. On cytological examination of the aspirates, only 3 (23%) cases showed specific epithelioid cells, whereas 8 (61.5%) cases showed non-specific inflammation, and 2 (15.3%) cases had no inflammatory cells.

CONCLUSION

Our study demonstrates that in the field of laboratory diagnosis of PNL cases, FNAC in combination with ZN staining for acid-fast bacilli (AFB) and Multiplex-PCR can provide a rapid and definitive diagnosis for the majority of PNL cases. FNAC is a less-invasive, outdoor-based and simpler technique than invasive nerve biopsy procedure. Thus, this study may enlighten the future path for easy and reliable diagnosis of PNL.

摘要

背景

由于过度依赖临床专业知识，且缺乏简单而可靠的诊断工具，纯神经麻风（PNL）的诊断仍然具有主观性。Jardim 等人提出的诊断标准在发展中国家的临床医生中并未常规应用，因为它涉及到有创性的神经活检和复杂的抗 PGL-1 检测。我们进行了一项研究，使用细针抽吸细胞学（FNAC）结合 Ziehl-Neelsen 染色（ZN 染色）和针对麻风分枝杆菌的多重聚合酶链反应（PCR），对纯神经麻风（PNL）进行客观诊断，这种方法可能更简单，但同样可靠。

目的

本研究旨在通过 FNAC 结合 ZN 染色和多重 PCR 快速、简单而可靠地诊断纯神经麻风患者。

方法

将两位独立顾问诊断为 PNL 的 13 例患者作为病例纳入研究，另外 5 例非 PNL 患者作为对照。对受累神经进行细针抽吸，评估抽吸物的细胞学、ZN 染色和多重 PCR。

结果

在进行 FNAC 的 13 例病例中，5 例（38.4%）在常规抗酸染色的帮助下，11 例（84.6%）在多重 PCR 的帮助下，从神经组织抽吸物中检测到麻风分枝杆菌。在抽吸物的细胞学检查中，仅 3 例（23%）显示出特异性上皮样细胞，而 8 例（61.5%）显示出非特异性炎症，2 例（15.3%）无炎症细胞。