诊断支原体感染,血常规很重要!

2017-04-02 黄元兰 中国人民解放军第455医院 中华检验医学网

支原体(mycoplasma):又称霉形体,为目前发现的最小的最简单的原核生物。支原体细胞中唯一可见的细胞器是核糖体(支原体是原核细胞,原核细胞的细胞器只有核糖体)。


【案例经过】

我在做血常规检查的时候,经常会发现一些标本肉眼观察呈絮状,血球仪检测时红细胞计数偏低,但红细胞平均体积(MCV)却异常增高,提示细胞发生了凝集。这种情况在秋冬季节十分明显,尽管我已经遇见了很多例,但是一直不知道这有什么临床意义,只知道此类标本经温浴解聚后方能进行检测。

那段时间我正在准备研究生入学考试,在复习内科学呼吸系统疾病的时候,我发现教科书上关于支原体感染性肺炎的描述有这么一条:多数肺炎支原体感染性肺炎患者冷凝集试验阳性……

我恍然大悟,平时做血常规所见的上述现象不就是冷凝集吗?这些患者多为小儿科或者呼吸科患者,大部分临床诊断都是下呼吸道感染,难道这些患者都是支原体感染性肺炎?某日,我半信半疑地查看了血球仪里存有记录的几个有冷凝集现象的患者的资料,发现这些患者确实大多是来自呼吸科或者儿科的的呼吸道感染病例,这初步证实了我的想法。随后我开始到网上各大数据库查找相关资料,想进一步证实,结果确实发现了不少此方面的案例。

没过几天,我又碰见了一个冷凝集的标本,患者男性,25岁,因咳嗽两周,进行性加重入住我院呼吸科。我立刻拨通了该患者主治医生老林的电话,谈了下自己的看法。电话的那一头,老林十分激动地说:“这个患者入院后,我立即采用了头孢三代抗生素予以治疗,但是不见好转。痰培养也未查见相关致病菌,我也怀疑患者是支原体感染,但是一直苦于没有证据。”我所提供的情况很重要,在一定程度上支持支原体感染的诊断,他准备立即改用红霉素予以治疗……

两周后,患者顺利康复出院。此后每次遇见疑似支原体感染病例,老林都会打电话问我是否有冷凝集现象,当然,每次遇到冷凝集现象,我也会主动与老林进行沟通。


【分析与心得】

支原体感染的病例在临床上日益增多,由于支原体无细胞壁,部分常用抗生素如头孢菌素类和青霉素类对支原体感染的治疗往往无效;同时,由于缺乏特异性的症状,加之支原体培养十分困难、血清支原体抗体检测也部分存在假阳性和假阴性,其诊断一直十分棘手。因此支原体感染后,血液标本在体外出现冷凝集现象,不失为辅助诊断支原体感染廉价、方便和快捷的诊断方法,值得临床推广。

这个案例告诉我们:检验医师不应该把自己的工作局限在实验室以内,把自己的任务定格为出一份准确的检验报告,而更应该加强与临床医师的联系,学会用实验室的技术和手段,解决临床问题。


【经典箴言】

血液标本体外冷凝集可辅助诊断支原体感染。

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    2023-01-02 zwddoctor 来自北京

    学习了

    0

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    2017-04-21 小康子70

    真的很实用,以后会留心的

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=2108478, encodeId=be4821084e835, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3a31581237, createdName=zwddoctor, createdTime=Mon Jan 02 09:33:54 CST 2023, time=2023-01-02, status=1, ipAttribution=北京), GetPortalCommentsPageByObjectIdResponse(id=2053992, encodeId=d5b82053992a1, content=<a href='/topic/show?id=fde15e0670c' target=_blank style='color:#2F92EE;'>#支原体感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57067, encryptionId=fde15e0670c, topicName=支原体感染)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqPdWFricgmt6Dde2ptNxJzD6Y9c4cxpXdTo4pNlVPARAnFdKu6nWIPele9icxApTaFgibq0uVlgRiceQ/132, createdBy=4b8c2500026, createdName=ms8435843352634314, createdTime=Tue Dec 19 10:37:00 CST 2017, time=2017-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189485, encodeId=45eb18948594, content=真的很实用,以后会留心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83ep3KyYH7kyqVwUwK81ibQRkWMqRMVwerlwD2Ie9byeRp2RL9wKmLgoNwShDTdTNL8RQHfhDsAt0N9A/132, createdBy=99b61684657, createdName=小康子70, createdTime=Fri Apr 21 23:19:28 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614712, encodeId=998f1614e1279, content=<a href='/topic/show?id=1f0a5e0662f' target=_blank style='color:#2F92EE;'>#支原体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57066, encryptionId=1f0a5e0662f, topicName=支原体)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fb019527746, createdName=ms5906905816781247, createdTime=Tue Apr 04 14:37:00 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185072, encodeId=772d1850e20a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06e71731984, createdName=galeno, createdTime=Tue Apr 04 09:27:48 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184835, encodeId=800f184835a8, content=学习了谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Apr 03 11:23:57 CST 2017, time=2017-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184816, encodeId=e82c184816de, content=学习了谢谢了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Mon Apr 03 09:43:09 CST 2017, time=2017-04-03, status=1, ipAttribution=)]
    2017-04-04 galeno

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2108478, encodeId=be4821084e835, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3a31581237, createdName=zwddoctor, createdTime=Mon Jan 02 09:33:54 CST 2023, time=2023-01-02, status=1, ipAttribution=北京), GetPortalCommentsPageByObjectIdResponse(id=2053992, encodeId=d5b82053992a1, content=<a href='/topic/show?id=fde15e0670c' target=_blank style='color:#2F92EE;'>#支原体感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57067, encryptionId=fde15e0670c, topicName=支原体感染)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqPdWFricgmt6Dde2ptNxJzD6Y9c4cxpXdTo4pNlVPARAnFdKu6nWIPele9icxApTaFgibq0uVlgRiceQ/132, createdBy=4b8c2500026, createdName=ms8435843352634314, createdTime=Tue Dec 19 10:37:00 CST 2017, time=2017-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189485, encodeId=45eb18948594, content=真的很实用,以后会留心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83ep3KyYH7kyqVwUwK81ibQRkWMqRMVwerlwD2Ie9byeRp2RL9wKmLgoNwShDTdTNL8RQHfhDsAt0N9A/132, createdBy=99b61684657, createdName=小康子70, createdTime=Fri Apr 21 23:19:28 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614712, encodeId=998f1614e1279, content=<a href='/topic/show?id=1f0a5e0662f' target=_blank style='color:#2F92EE;'>#支原体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57066, encryptionId=1f0a5e0662f, topicName=支原体)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fb019527746, createdName=ms5906905816781247, createdTime=Tue Apr 04 14:37:00 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185072, encodeId=772d1850e20a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06e71731984, createdName=galeno, createdTime=Tue Apr 04 09:27:48 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184835, encodeId=800f184835a8, content=学习了谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Apr 03 11:23:57 CST 2017, time=2017-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184816, encodeId=e82c184816de, content=学习了谢谢了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Mon Apr 03 09:43:09 CST 2017, time=2017-04-03, status=1, ipAttribution=)]
    2017-04-03 半夏微凉

    学习了谢谢!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2108478, encodeId=be4821084e835, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3a31581237, createdName=zwddoctor, createdTime=Mon Jan 02 09:33:54 CST 2023, time=2023-01-02, status=1, ipAttribution=北京), GetPortalCommentsPageByObjectIdResponse(id=2053992, encodeId=d5b82053992a1, content=<a href='/topic/show?id=fde15e0670c' target=_blank style='color:#2F92EE;'>#支原体感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57067, encryptionId=fde15e0670c, topicName=支原体感染)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqPdWFricgmt6Dde2ptNxJzD6Y9c4cxpXdTo4pNlVPARAnFdKu6nWIPele9icxApTaFgibq0uVlgRiceQ/132, createdBy=4b8c2500026, createdName=ms8435843352634314, createdTime=Tue Dec 19 10:37:00 CST 2017, time=2017-12-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189485, encodeId=45eb18948594, content=真的很实用,以后会留心的, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83ep3KyYH7kyqVwUwK81ibQRkWMqRMVwerlwD2Ie9byeRp2RL9wKmLgoNwShDTdTNL8RQHfhDsAt0N9A/132, createdBy=99b61684657, createdName=小康子70, createdTime=Fri Apr 21 23:19:28 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614712, encodeId=998f1614e1279, content=<a href='/topic/show?id=1f0a5e0662f' target=_blank style='color:#2F92EE;'>#支原体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57066, encryptionId=1f0a5e0662f, topicName=支原体)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7fb019527746, createdName=ms5906905816781247, createdTime=Tue Apr 04 14:37:00 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185072, encodeId=772d1850e20a, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=06e71731984, createdName=galeno, createdTime=Tue Apr 04 09:27:48 CST 2017, time=2017-04-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184835, encodeId=800f184835a8, content=学习了谢谢!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5nmIH5IQqCKjJgSCuicPWUWOUcdqt1ROPnEiaOYN4pSHibDv8la3OxNLalvuvUXn8clpJlrpuyTpckgt9OPkeSSdT/0, createdBy=8fd71930726, createdName=半夏微凉, createdTime=Mon Apr 03 11:23:57 CST 2017, time=2017-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184816, encodeId=e82c184816de, content=学习了谢谢了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLPeNmuNF9ibgMfMOAs7Iic5MpiaU8RLmRH67xCKuk5wzfhb7G4ib7ia6z9lrnsTicj1nAUfEOMecZDtvvu/0, createdBy=d7f91939785, createdName=186****0580(小山羊), createdTime=Mon Apr 03 09:43:09 CST 2017, time=2017-04-03, status=1, ipAttribution=)]
    2017-04-03 186****0580(小山羊)

    学习了谢谢了。

    0

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