双氢青蒿素对卡氏肺孢子虫肺炎大鼠TNF-α水平的影响

目的研究双氢青蒿素治疗对卡氏肺孢子虫肺炎大鼠血清和肺泡巨噬细胞培养上清液 TNF- α水平的影响。方法以醋酸可的松皮下注射 Wistar大鼠建立卡氏肺孢子虫肺炎动物模型 ,用 60 m g/ kg双氢青蒿素治疗实验大鼠 ,杀鼠取肺 ,用胶原酶消化法分离肺泡巨噬细胞 ,用 L PS刺激培养 72 h,同时设有感染组和正常对照。用 TNF- α试剂盒分别检测血清和培养上清液 TNF- α的水平。结果感染组和治疗组 TNF- α水平均高于正常对照 ,治疗组 TNF- α水平则低于感染组。结论卡氏肺孢子虫感染引起大鼠肺泡巨噬细胞分泌高水平的 TNF- α,但双氢青蒿素治疗后 PCP大鼠肺泡巨噬细胞产生 TNF- α水平降低。     

双氢青蒿素对卜氏肺孢子虫肺炎大鼠TNF—α水平的影响

目的 研究双氢青蒿素对卡氏肺孢子虫肺炎大鼠血清和肺泡巨噬细胞培养上清液TNF－α水平的影响。方法 以醋酸可的松皮下注射Wistar大鼠建立卡氏肺孢子虫肺炎动物模型,用60mg/kg双氢青蒿素治疗实验大鼠,杀鼠取肺,用胶原酶消化法分离肺泡巨噬细胞,用LPS刺培养72h,同时设有感染组和正常对照,用TNF－α水平则低于感染组。结论 卡氏肺孢子虫感染引起大鼠肺泡巨噬细胞分泌高水平的TNF－α,但双氢青蒿素治疗后PCP大鼠肺泡巨噬细胞产生TNF－α水平降低。     

实验性卡氏肺孢子虫肺炎的病理学研究

Ｗｉｓｔａｒ大鼠皮下注射醋酸考的松诱发卡氏肺孢子虫肺炎，自第６～１２周，每周解剖病鼠２只观察，全部给药鼠均发病。肺部病变表现为：（１）肺印片查见卡氏肺孢子虫包囊和滋养体。（２）组织病理学改变：第６～８周ＨＥ染色切片呈间质性肺炎伴中度淋巴细胞浸润，肺泡内缺乏泡沫样渗出物，第９～１２周肺泡内出现泡沫样渗出物，ＰＡＳ染色该渗出物呈阳性反应，ＧＭＳ染色查见染成黑色的包囊。（３）停用醋酸考的松后４～６周，肺部炎症明显好转，提示大鼠卡氏肺孢子虫肺炎有自愈可能。电镜显示包囊、滋养体及受损肺泡上皮细胞的超微结构。     

卡氏肺孢子虫肺炎大、小鼠低死亡率动物模型的建立

为建立低死亡率卡氏肺孢子虫肺炎 (PCP)SD大鼠和ICR小鼠动物模型 ,本试验将雌性SD大鼠和ICR小鼠分别随机分为实验组和对照组 ,实验组采用按体重定量皮下注射地塞米松的方法 ,免疫抑制诱导建立PCP动物模型 ,对照组注射与地塞米松等体积的生理盐水。分别制作肺印片 ,经瑞 姬氏复合染色后 ,检查卡氏肺孢子虫包囊。制作肺组织病理切片 ,经HE染色后观察肺组织病理变化。用地塞米松诱导后 ,实验组SD大鼠和ICR小鼠死亡率均为 0 ,肺印片阳性率均为 76 7% (2 3 30和 2 3 30 )。肺组织出现典型的病理变化 ,并可观察到Pc包囊。实验组SD大鼠体重下降明显 ,与对照组体重比较具有极显著性差异 (P <0 0 1)。ICR小鼠经诱导后 ,体重变化不显著。采用按体重定量皮下注射地塞米松的方法可建立低死亡率PCP动物模型     

卡氏肺大鼠肺泡巨噬细胞TNF-α、IL-1β、IL-6基因表达的变化

目的探讨卡氏肺孢子虫肺炎(Pneumocysitis carinii pneumonia,PCP)大鼠肺泡巨噬细胞(Alveolar macrophage,AM)TNF-α、IL-1β、IL-6基因表达的变化。方法采用AM体外培养技术,应用RT-PCR法分别测定脂多糖(LPS)诱导的AM中TNF-α、IL-1β、IL-6基因表达的动态变化。结果肺泡巨噬细胞受LPS刺激后,PCP模型大鼠TNF-αmRNA在1、4 h表达高于正常组(P<0.05),IL-1βmRNA表达在4、8 h时表达高于正常组(P<0.01),IL-6mRNA表达在8 h时PCP高于正常(P<0.05),表达峰值都提前,并且在4 h达到峰值。结论LPS刺激后,PCP大鼠肺泡巨噬细胞在早期可能更易分泌TNF-α、IL-1β、IL-6作为免疫分子,起免疫防御和免疫损伤作用。     

卡氏肺孢子虫病的诊断及其进展

卡氏肺孢子虫病诊断方面的研究表明，辅助诊断方法缺乏特异性，在确定病人是否有肺感染，感染的程度及疗效的考核上都有一定作用。但ＰＣ感染的最后确诊主要靠病原体检测。取材方法：对于肺感染者应以导痰为首选，其次是ＢＡＬ和ＴＢＬＢ。儿童可采用经皮穿刺肺吸引的方法取材。在前述方法无法实施的紧急情况下，才考虑开胸肺活检。肺外感染者可在病变局部穿刺取材。制片法：可用穿刺物或肺组织等做直接涂片，印片，或悬液滴片等简捷方法，也可采用组织切片。染色方法：常用Ｇｉｅｍｓａ、初检、ＴＢＯ或ＧＭＳ法进一步确诊。ＩＦ可提高检出率。ＰＣＲ技术检测孢子虫病更敏感和特异，有操作简便，易于推广应用等优点。     

肾小球肾炎患者免疫抑制治疗后并发卡氏肺孢子虫肺炎

目的 研究糖皮质激素联合细胞毒药物治疗肾小球肾炎并发卡氏肺孢子虫肺炎（PCP）的临床表现。方法 回顾性分析3例糖皮质激素联合细胞毒药物治疗肾小球肾炎并发PCP的临床，并复习相关文献资料。结果 3例患者年龄为28～67岁，男性2例，女性1例。1例为原发性肾小球肾炎、1例为狼疮性肾炎、1例为显微镜下多血管炎致新月体肾炎。PCP表现均出现在接受糖皮质激素联合细胞毒药物（包括环磷酰胺、雷公藤多甙片、甲氨喋呤）过程中，其中1例曾给予甲基强的松龙冲击治疗。3例均表现为发热、进行性呼吸困难、Ⅰ型呼吸衰竭，影像学检查提示双肺弥漫性间质病变；2例痰涂片发现号氏肺孢子虫（PC）包囊，1例痰聚合酶链反应检测Pc阳性。2例经复方新诺明治疗后痊愈，1例死亡。结论 肾小球肾炎患者免疫抑制治疗后出现进行性低氧血症应考虑PCP的可能性，需早期诊断、治疗。     

补中益气汤对肺孢子虫肺炎模型大鼠细胞免疫影响的实验研究

目的观察补中益气汤煎剂对卡氏肺孢子虫肺炎模型大鼠的免疫调节作用。方法Waster雌性大鼠60只,随机分成正常对照组、模型对照组、西药治疗对照组、中药治疗组及中药预防组。除正常组外其他4组均参照国内外公认的造模方法建立肺孢子虫肺炎模型。模型对照组生理盐水灌胃：西药治疗对照组与中药治疗组于实验第5周起至第6周分别给予复方新诺明及补中益气汤煎剂灌胃;中药预防组于实验第1周起以补中益气汤煎剂灌胃。于实验第6周末处死各组大鼠并检测各组大鼠淋巴细胞转化率和T细胞亚群百分比。结果正常组大鼠淋巴细胞转化率、CD4＋T细胞数量和CD4＋／CD8＋的值高于模型组,其差异具有统计学意义。中药预防组大鼠淋巴细胞转化率、CD4CF细胞数量和CD4＋／CD8＋的值高于西药治疗组和模型组。预防组大鼠CD4＋、CD4＋／CD8＋的值与正常组差异无统计学意义。西药治疗组CD4＋、CD4＋／CD8＋的值与模型组无差异。结论正常组与中药预防组大鼠T淋巴细胞转化率高于模型组,CD4＋T细胞数量的减少与PCP的发生具有密切关系,正常组与中药预防组CD4＋T细胞数量高于模型组,补中益气汤能够提高卡氏肺孢子虫肺炎模型大鼠淋巴细胞转化率和CD4＋T细胞的数量,在本实验中中药预防组的效果尤为显著,证实该方剂对大鼠肺孢子虫肺炎具有防治作用。     

Alveolar macrophages in AIDS patients: increased spontaneous tumour necrosis factor-alpha production in Pneumocystis carinii pneumonia.

In order to assess the role of alveolar macrophages and their products in the control of Pneumocystis carinii pneumonia (PCP) and other infections in AIDS, bronchoalveolar lavage cells and peripheral blood mononuclear cells from HIV-positive AIDS/ARC patients (with and without PCP) and HIV-negative patients were counted and cultured in vitro; spontaneous and LPS-induced tumour necrosis factor-alpha (TNF-alpha) production was measured. Markedly increased spontaneous TNF-alpha production by alveolar macrophages and, to a lesser extent, peripheral blood monocytes was found in HIV-positive patients with active PCP but not in patients without the infection. Higher TNF production was associated with lower counts of Pneumocystis in the bronchoalveolar lavage fluid. These results suggest that TNF-alpha production by macrophages may play an important role in the control of Pn. carinii infection in AIDS.     

Observations favouring Pneumocystis carinii pneumonia as a primary infection: a monoclonal antibody study on paraffin sections

Pneumocystis carinii pneumonia is characteristic of immunodeficiency and the organism is probably acquired during early childhood. Since infection is only manifest in the lungs, it has been presumed that the organism lies dormant in these tissues following the primary infection. Conventional staining procedures have, however, failed in the absence of pneumonia to demonstrate consistently any forms of Pneumocystis carinii. To study this problem further, lung sections and hilar lymph nodes from immunodepressed adults with and without Pneumocystis carinii pneumonia as well as lung sections from presumed immunocompetent patients were examined for the cyst and trophozoite forms of Pneumocystis carinii using a monoclonal antibody. The organism was only identified in areas of pneumonia, and the source of the organism in these patients may therefore be a new infection with a different human subtype and not, as previously thought, reactivation of a primary infection.     

艾滋病与非艾滋病病例合并卡氏肺孢子菌肺炎的临床特征对比研究

目的:比较艾滋病相关性卡氏肺孢子菌肺炎与非艾滋病相关性卡氏肺孢子菌肺炎的临床特征及辅助检查,以提高临床医师诊疗水平。方法:收集2018年1月至2021年7月在某三甲医院确诊的卡氏肺孢子菌肺炎17例,按照不同基础疾病将病例分为艾滋病组（7例）与非艾滋病组（10例）,比较两组病例的人口学特征、临床表现、实验室检查、病原学以...     

Epidemiology of Pneumocystis carinii pneumonia in southern Spain

In order to investigate the impact of Pneumocystis carinii infection in southern Spain following the introduction of highly active anti-retroviral therapy (HAART), all cases of pneumocystosis between 1998 and 1999 were identified from data compiled by the national surveillance system. In total, 498 cases of pneumocystosis were recorded, of which 87% involved HIV-positive patients. The mean age, length of hospital stay and mortality were higher for HIV-negative patients. There was a higher number of cases in winter. Despite HAART implementation, pneumocystosis remains a significant health problem for both HIV-positive and HIV-negative patients.     

Clinical significance of nested polymerase chain reaction and immunofluorescence for detection of Pneumocystis carinii pneumonia

Objective   To study the clinical significance of a nested polymerase chain reaction (PCR) method compared to immunofluorescence (IF) for detection of Pneumocystis carinii .
Methods   The medical records of 89 patients with 91 episodes of pneumonia were scrutinised retrospectively. The pneumonia episodes were divided into categories according to the likelihood that the patient had had clinical Pneumocystis carinii pneumonia (PCP). All respiratory tract samples from the 89 patients (34 broncho-alveolar lavage (BAL) and 57 sputa) were tested for Pneumocystis carinii by IF and nested PCR.
Results   Fifteen episodes, as diagnosed by IF, were classified as true PCP (combination of the groups with definite and probable PCP; sensitivity 60%, specificity 97%). Among the P. carinii DNA-positive episodes, detected with nested PCR, 24 were classified as true PCP (combination of the groups with definite and probable PCP; sensitivity 96%, specificity 59%), since all IF-positive samples were nested PCR positive. Only one pneumonia episode classified as a probable PCP, was negative with both methods, as applied to a BAL sample.
Conclusions   IF applied to BAL or sputum seems to be the most specific method for diagnosis of clinical PCP. Additional clinical cases can be found by nested PCR, although this then gives a high risk of detecting subclinical colonisation of P. carinii .     

Foamy alveolar casts: diagnostic specificity for Pneumocystis carinii pneumonia in bronchoalveolar lavage fluid cytology

Pneumocystis carinii pneumonia (PCP) is a major infectious complication of immunodeficiency states, including the acquired immunodeficiency syndrome (AIDS). Bronchoalveolar lavage (BAL) is a safe and effective procedure for making this diagnosis. In addition to the characteristic organisms, both histologic and cytologic material often reveals exudate in the form of foamy alveolar casts (FACs). To test the diagnostic utility of FACs in BAL fluids, we compared 20 PCP-positive and 28 PCP-negative fluids as assessed by silver stains. All PCP-positive fluids contained FACs on Papanicolaou-stained material. Only one PCP-negative lavage contained FACs, and transbronchial biopsy in this case revealed PCP. We suggest that FACs in BAL fluids are highly sensitive and specific for the diagnosis of PCP.     

Autopsy case of alcoholic hepatitis and cirrhosis treated with corticosteroids and affected by Pneumocystis carinii and cytomegalovirus pneumonia

A case of the very early phase of Pneumocystis carinii pneumonia in a human immunodeficiency virus (HIV)-negative man with alcoholic hepatitis and cirrhosis treated with steroids is presented. A 40-year-old man with a 10-year history of alcohol abuse was admitted to hospital with jaundice, fever and macrohematuria. Laboratory examinations revealed neutrophilic leukocytosis and a serum bilirubin level of 13.9 mg/dL. The serum bilirubin level rose to 28.5 mg/dL over 1 month. Prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever. After an interval of a week, it was resumed and maintained for 22 days (total dose, 1555 mg) until the patient died of a massive hemorrhage from ruptured vessels of a gastric ulcer. An autopsy disclosed P. carinii pneumonia in the lower lobe of the left lung, cytomegalovirus infection in both lungs and the esophagus, and esophageal candidiasis. To our knowledge, this is the first report of P. carinii pneumonia together with cytomegalovirus infection in an HIV-negative alcoholic patient. The present case suggests that a rare opportunistic infection such as P. carinii pneumonia might be caused by treating cirrhosis and alcoholic hepatitis with corticosteroids, even if only for a relatively short period.     

瑞香素联合母牛分支菌治疗大鼠卡氏肺孢子菌肺炎的实验研究

目的探讨瑞香素和母牛分支菌联合对大鼠卡氏肺孢子菌肺炎(PcP)的治疗作用。方法地塞米松腹股沟皮下注射SD大鼠8周,建立PcP大鼠模型,将其随机分为模型对照组,瑞香素组,母牛分支菌组,瑞香素与母牛分支菌联合用药组,并设立正常对照组。观察肺病理切片、肺印片中每视野肺孢子菌包囊均数、脾细胞增殖能力及血清INF-γ水平变化。结果治疗组肺孢子菌包囊数较模型组明显减少,肺组织损伤较模型组减轻或修复,脾细胞增殖能力及血清INF-γ水平治疗组较模型组有不同程度的提高,其中联合用药组较单用组效果显著。结论瑞香素和母牛分支菌联合用药治疗卡氏肺孢子菌肺炎大鼠较单用疗效显著。     

Pneumocystis carinii in FNA of the thyroid.

We report the diagnosis of Pneumocystis carinii (PC) in a fine-needle aspirate (FNA) from the thyroid of a human immunodeficiency virus infected (HIV+) male receiving aerosolized pentamidine as prophylaxis for Pneumocystis carinii pneumonia (PCP). The clinical diagnosis prior to FNA was multinodular goiter. The patient did not have pulmonary symptoms nor previous diagnosis of PCP at the time of the aspirate diagnosis. Recently, extrapulmonary Pneumocystis carinii (EPC) has been reported with increasing frequency in HIV+ patients receiving prophylactic aerosolized pentamidine. Awareness of extrapulmonary presentations of Pneumocystis carinii infection is a prerequisite for accurate cytologic diagnosis.