【作者】 周道银； 凌励； 俞靖龙； 许育； 王学；

【Author】 Zhou Daoying, Lin Li, Yu Jinglong, Xu Yu, Wang Xue. The department of laboratory diagnosis, Changhai Hospital, Shanghai 200433

【机构】 上海长海医院实验诊断科；

【摘要】 不明原因和性质的胸腹心包腔积液患者中,常见危重疑难病例,获得及时明确诊断非常重要。胸腹心包腔积液一般性检查作为传统的常规项目被临床所首选,积液常规检查主要内容为颜色、透明度、蛋白定性、细胞计数及分类,检验目的主要用于渗出液与漏出液的鉴别。作者对传统的常规检验方法进行改进,应用同一份标本,在完成常规检验的基础上,同时进行细胞学及形态学(寄生虫、细菌、真菌、结晶等)检验,建立了常规细胞形态学快速检验诊断技术,关键技术是:①二步离心浓集细胞;②以推片法制作有尾薄片和厚片及无尾片各2张;③对凝固标本处理后制片染色,作细胞学(分类)和形态学检查;④以改良的瑞吉复合染剂染色涂片;⑤显徽镜观察多份涂片;⑥将简单的细胞分类改为细胞分类+细胞学四级描述形式。该改进技术达到了收集细胞多,染色时间短,易于鉴定肿瘤细胞和检出其它形态病原体的效果,从而使积液常规检验提升为可以判断积液原因和性质的一项诊断试验。采用改进技术共检验积液标本12000例。检出恶性细胞3100例;恶性细胞检出阳性率达78%,与最终诊断符合率达94.3%-98.8%。检出其它阳性结果或病原体4866例。检出少见报道的卡氏肺孢子虫、狼疮细胞、骨髓瘤细胞、神经母瘤细胞、淋巴瘤细胞、白血病细胞、郎罕细胞、胆固醇结晶、胆红素结晶等。首先检出并报道了免疫岛、血细胞围瘤花环、噬菌细胞、有核细胞包裹杆菌等。为临床诊断,尤其是为某些危重疑难病例诊断提供了及时可信的诊断指标,为临床对病人及早诊治提供了重要依据。更多还原

【Abstract】 There are some critical and complicated ones among those who had pleural effusion, ascites or pericardial effusion of unknown origin or cause, and it is very important to obtain correct diagnosis timely for them. As a traditional routine, Pleural effusion, ascites and pericardial effusion assay are the first selection of clinical physician, which include color, transparency,protein determining, cell counting and classifying, and its aim is to define the exudates and excaped fluid. The traditional assay was modified in this paper to achieve the cytological and morphological tests (parasite, bacterium, fungi, crystal and so on) besides the routine items and set up rapid cytomorphological technology. In brief, 1 cell enriched by twice centrifuge, 2 thin or thick smears with or without tails was build twice respectively, 3 concreting specimen treatment followed by staining, cell classification and morphological test, 4 smears stained using modified Wright and Gimsa stain, 5 inspected smears with microscopy, 6 cell classification was added for grade description of cytomorphology. This modified technology can enrich more cells, shortened staining time, and was benefit for defining tumor cells and finding pathogens. Thus, the modified assay became a diagnostic test which can definite the cause and characters of effusion. 12,000 specimens have been done according to this modified protocol, and malignant cells have been found in 3100 specimens that the positive ratio reached 78% and accurate ratio reached 94.3~98.8%. In addition, other positive finding and pathogen have been found in 4866 specimen, which include the unfrequent finding such as pneumocystis carinii,lupus cell, myeloma cell, neuroblasts cell, lymphoma cell, leukemia cell, Langhan cell, cholesterin crystal and bilirubin crystal. To our knowledge, the findings of immune island, blood corpuscle surrounding tumor cells, cells englobing bacterium and nuclear cells cycling bacillus were first reported in the world. These findings provided believable and important evidences for clinical diagnosis and early treatment, especially those critical and complicated patients.更多还原