支气管肺泡灌洗液常规细胞形态学检查的临床应用价值评价

目的通过对2005年1月～2010年12月长海医院860例支气管肺泡灌洗液常规细胞形态学检查结果回顾分析,评价其临床应用价值。方法用10 mL塑料离心管留取支气管肺泡灌洗液5～10 mL,500 g,离心5 min,弃上清液吸取沉淀物制片,采用推片法制6张涂片,其中无尾厚片、有尾厚片、有尾薄片各2张。涂片染色采用瑞吉染色法,由经验丰富的细胞形态学检验人员在普通光学显微镜下进行单核/巨噬细胞、淋巴细胞、中性粒细胞、嗜酸性粒细胞等分类以及细胞形态、异常成份观察,必要时涂片行过碘酸-雪夫(PAS)、含铁血黄素染色等。结果 (1)常规细胞分类计数,中性粒细胞比例>2%者764例,占总例数的88.8%,其中>20%者406例,占总例数的47.2%;淋巴细胞比例>12%者234例,占总例数的27.2%,其中>20%者135例,占总例数的15.7%;嗜酸性粒细胞比例>1%者64例,占总例数的7.4%,其中32例>10%,占总例数的3.2%;(2)860例标本中查见异常成份的117例,占总例数的13.6%。其中查见癌细胞16例、查见核异质细胞(异型细胞)或可疑癌细胞共43例、查见真菌14例、查见卡氏肺孢子虫3例、查见噬菌细胞2例、PAS染色阳性33例、含铁血黄素染色阳性6例;(3)860例标本中未见异常的(单核/巨噬细胞≥85%且未见其他异常成分)仅46份,占总例数5.3%。结论本院送检支气管肺泡灌洗液常规检查标本,实验室异常检出率高,可以为临床多种疾病的诊断、治疗和预后分析提供有价值的参考信息。

Clinical application value evaluation of routine cytomorphology examination in bronchoalveolar lavage fluid

Objective To evaluate the clinical application value of routine cytomorphology examination in 860 bronchoalveolar lavage fluid samples collected from January 2005 to December 2010 in Changhai Hospital by retrospective analysis.Methods The 5-10 mL bronchoalveolar lavage fluid was collected in 10 mL plastic centrifuge tube and was centrifuged（500 g,5 min）.The sediment was then loaded on microscopic slides,and ordinarily 6 smears were produced,including 2 thick slides without tails,2 thick slides with tails and 2 thin slides with tails.Wright-Giemsa was performed,and the monocytes/macrophages,lymphocytes,neutrophils,eosinophils,et al,cytomorphology and abnormal constituents were further counted and differentiated by experienced technicians under light microscopy.Periodic acid-Schiff（PAS） stain and hemosiderin staining were also performed if necessary.Results Neutrophil ratio 2% or 20% accounted for 88.8%（764 cases） or 47.2 %（406 cases） of the total 860 patients,respectively.Lymphocyte ratio 12% or 20% accounted for 27.2%（234 cases） or 15.7%（135 cases）,respectively.Eosinophil ratio1% or 10% accounted for 7.4%（64 cases） or 3.2%（32 cases）.A total of 117 cases accounted for 13.6% were found to have abnormal constituents,including cancer cells in 16 cases,heterogeneous nuclear or suspected cancer cells in 43 cases,fungus in 14 cases,Pneumocystis carinii in 3 cases and phagocytes in 2 cases.PAS stain positive had 33 cases,and hemosiderin staining positive had 6 cases.There were only 46 samples in which no abnormality was identified,accounting for 5.3% of total cases.Conclusions High detection rates of abnormality in bronchoalveolar lavage fluid are identified,the high detection rates can provid helpful clinical reference for the diagnosis,treatment and prognosis of various diseases.