Bown J W, Savides T J, Mathews C, Isenberg J, Behling C, Lyche K D
Division of Gastroenterology, University of California at San Diego Medical Center, USA.
Am J Gastroenterol. 1996 Nov;91(11):2289-92.
To evaluate the diagnostic yield of performing duodenal biopsies and aspirates in AIDS patients with chronic diarrhea.
Retrospective review of esophagogastroduodenoscopy (EGD) records from January 1993 to March 1995 to identify those patients who underwent EGD for evaluation of AIDS associated diarrhea and had a duodenal biopsy and/or aspirate. Biopsies were examined for pathogens using routine histology and special stains, viral culture, and electron microscopy. Duodenal aspirates were evaluated for ova and parasites. All patients had previous negative stool studies. Pathology laboratory charges (hospital and professional fees) for each test and charges per positive test were determined.
Of the 57 patients included in this study, 56 had a duodenal biopsy and 42 had a duodenal aspirate. An established pathogen was identified in only 15 (26%) patients. One patient had both Mycobacterium avium complex and microsporidia. Pathogens were identified in seven patients by hematoxylin and eosin stain, in three patients by acid-fast bacillus stain, and in six patients by electron microscopy. No pathogens were identified with Gomori's methenamine silver stain (44 patients), duodenal aspirate for ova and parasites (46 patients), immunoperoxidase stains (4 patients), or viral culture (4 patients). Cryptosporidia were identified in six, microsporidia in five, Mycobacterium avium complex in three, and Giardia lamblia and adenovirus each in one patient.
In this series, the diagnostic yield of EGD with duodenal biopsy and aspirate in AIDS associated diarrhea was low. Pathogens were identified in 26% of patients; predominantly Cryptosporidium organisms and microsporidia. The routine performance of aspiration of duodenal contents for parasite examination and staining of duodenal tissue with Gomori's methenamine silver stain for fungal identification are not recommended. One should consider obtaining tissue for electron microscopy whenever duodenal biopsies are performed. The utility of EGD in AIDS associated diarrhea may improve as more effective therapies become available.
评估对患有慢性腹泻的艾滋病患者进行十二指肠活检和抽吸物检查的诊断价值。
回顾性分析1993年1月至1995年3月间的食管胃十二指肠镜检查（EGD）记录，以确定那些因评估艾滋病相关性腹泻而接受EGD检查并进行了十二指肠活检和/或抽吸的患者。活检标本采用常规组织学、特殊染色、病毒培养和电子显微镜检查病原体。十二指肠抽吸物检查虫卵和寄生虫。所有患者之前的粪便检查均为阴性。确定了每项检查的病理实验室费用（医院和专业费用）以及每次阳性检查的费用。
本研究纳入的57例患者中，56例进行了十二指肠活检，42例进行了十二指肠抽吸。仅在15例（26%）患者中发现了确诊的病原体。1例患者同时感染了鸟分枝杆菌复合体和微孢子虫。通过苏木精和伊红染色在7例患者中发现病原体，抗酸杆菌染色在3例患者中发现病原体，电子显微镜检查在6例患者中发现病原体。采用Gomori六胺银染色（44例患者）、十二指肠抽吸物检查虫卵和寄生虫（46例患者）、免疫过氧化物酶染色（4例患者）或病毒培养（4例患者）均未发现病原体。6例患者发现隐孢子虫，5例发现微孢子虫，3例发现鸟分枝杆菌复合体，1例患者分别发现蓝氏贾第鞭毛虫和腺病毒。
在本系列研究中，EGD联合十二指肠活检和抽吸对艾滋病相关性腹泻的诊断价值较低。26%的患者发现了病原体；主要是隐孢子虫和微孢子虫。不建议常规进行十二指肠内容物抽吸以检查寄生虫，以及用Gomori六胺银染色十二指肠组织以鉴定真菌。进行十二指肠活检时应考虑获取组织进行电子显微镜检查。随着更有效的治疗方法出现，EGD在艾滋病相关性腹泻中的应用价值可能会提高。
