探讨快速荧光染色在肺移植术后感染患者中的应用价值。

回顾性分析2021年9月至2024年7月在中国人民解放军总医院第八医学中心接受肺移植术后发生感染的19例患者资料。共计69例次呼吸道样本，每个样本同时进行微生物培养和快速荧光染色(包括组织细胞荧光染色和真菌荧光染色)，分析病原菌检出和分布情况，对快速荧光染色结果进行形态观察；并以微生物培养结果为对照，评价快速荧光染色法检出率、符合率、灵敏度和特异度。计数资料采用卡方检验比较。绘制受试者操作特征(ROC)曲线评价快速荧光染色对肺移植术后感染的诊断价值。P<0.05为差异具有统计学意义。

69例次呼吸道样本微生物培养共检出病原菌80株，杆菌、球菌和真菌分别为44株(55.0%)、11株(13.8%)和25株(31.2%)。组织细胞荧光染色检测阳性率为82.6%(57/69)，与细菌培养阳性率(85.5%)相比，差异无统计学意义(χ²＝0.460，P>0.05)；以细菌培养结果作为对照，组织细胞荧光染色检出细菌的符合率、灵敏度和特异度分别为85.5%、89.8%和60.0%。真菌荧光染色检测阳性率为39.1%(27/69)，与真菌培养阳性率(43.5%)相比，差异无统计学意义(χ²＝0.612，P>0.05)；以真菌培养结果作为对照，真菌荧光染色检测真菌的符合率、灵敏度和特异度分别为81.2%、73.3%和87.2%。组织细胞荧光染色诊断细菌感染和真菌荧光染色诊断真菌感染的ROC曲线下面积分别为0.749(P<0.05，95% CI: 0.558～0.940)和0.812(P<0.05，95% CI: 0.702～0.922)。

快速荧光染色能在短时间内初步鉴别细菌和真菌感染类型，直观评估感染的炎症反应程度，具有较高的诊断价值和临床应用价值。

To explore the application value of rapid fluorescence staining in patients with infection after lung transplantation.

A retrospective analysis was conducted on the results of rapid fluorescence staining (including tissue cell fluorescence staining and fungal fluorescence staining) and microbiological culture of 69 respiratory samples from 19 patients who underwent lung transplantation surgery at the 8th Medical Center of PLA General Hospital from September 2021 to July 2024. The microbiological culture results were analyzed for pathogen detection and distribution. Performing morphological observation and analysis on rapid fluorescence staining. And using microbial culture results as the gold standard, evaluate rapid fluorescence staining, including detection rate, conformity rate, sensitivity and specificity. Count data were compared using chi-square test. Using ROC curve to evaluate the diagnostic value of rapid fluorescence staining for infection in patients after lung transplantation.

In 69 respiratory tract sample microbiological cultures, 80 pathogenic bacteria were detected, with 44 strains (55.0%) of bacilli, 11 strains (13.8%) of cocci, and 25 strains (31.2%) of fungi. The positive rate of histocyte fluorescence staining was 82.6% (57/69), which showed no significant difference compared to the positive rate of microbiological culture (85.5%) (χ²=0.460, P>0.05). Using bacterial culture results as the gold standard, the consistency, sensitivity, and specificity of histocyte fluorescence staining for detecting bacteria were 85.5%, 89.8%, and 60.0%, respectively. The positive rate of fungal fluorescence staining was 39.1% (27/69), which showed no significant difference compared to the positive rate of fungal culture (43.5%) (χ²=0.612, P>0.05). Using fungal culture results as the gold standard, the consistency, sensitivity, and specificity of fungal fluorescence staining for detecting fungi were 81.2%, 73.3%, and 87.2%, respectively. The areas under the ROC curves for histocyte fluorescence staining in diagnosing bacterial infections and fungal fluorescence staining in diagnosing fungal infections were 0.749 (P<0.05, 95% CI: 0.558-0.940) and 0.812 (P<0.05, 95% CI: 0.702-0.922), respectively.

Rapid fluorescent staining can preliminarily identify the types of bacterial and fungal infections within a short period of time, and visually assess the degree of inflammatory response in infections, thus possessing high diagnostic and clinical application value.