肺隐球菌病临床和影像学分析  

Clinical and imaging analysis of pulmonary cryptococcosis

作　　者：江森[1] 朱晓华[1] 孙兮文[1] 丁嘉安[2] 易祥华[3] 虞栋[1] 尤正千[1] 马骏[1] 李天女[1] 彭刚[1] 

机构地区：[1]上海同济大学附属肺科医院影像科,200433 [2]上海同济大学附属肺科医院胸外科,200433 [3]上海同济大学附属肺科医院病理科,200433

出　　处：《上海医学影像》2005年第3期209-212,223,共5页Shanghai Medical Imaging

摘　　要：目的分析肺隐球菌病(PC)的临床特点和影像学表现以提高对该病的认识。方法回顾性分析我院2000-2004年间28例PC的临床、相关检查资料及影像学表现,并对所有PC患者的临床与影像学表现进行对照分析研究。结果28例PC,男性19例,女性9例,中青年为24例;7例有基础疾病;9例无任何症状,其余18例有咳嗽、咳痰、低热等轻度呼吸道症状;所有病例均经手术、肺穿刺、经纤支镜肺活检(TBLB)病理和细菌学确诊,其中26例行苏木素伊红和组织化学染色,均有隐球菌阳性提示;13例行核医学肺显像检查,12例诊断为恶性病变。28例PC影像学表现分为3种类型:肺结节、肿块(16例),肺炎样改变(7例),混杂性改变(5例);临床和影像学分析:(1)PC影像学表现为结节、肿块病变者临床症状较轻,而表现为炎症样改变和混杂性改变者临床症状较重。(2)有基础病变的PC患者多呈炎症样改变或混杂性改变,并且其临床症状相对较重。结论肺隐球菌病的临床和影像学表现不典型,临床应重视PC的存在,认识此病的特征,以提高对此病的诊断能力,并应积极开展病灶经皮肺穿刺及TBLB检查,减少开胸手术率。Purpose To analyze the clinical characteristic and medical imaging finding of pulmonary cryptococcosis （PC）. Methods From 2000 to 2004, 28 cases of PC were collected and retrospective studied by their clinical characteristics, related diagnosis data and imaging finding. The correlation study of imaging findings with clinical characteristics was performed for all cases. Results The patients consisted of 19 males and 9 females. 24 cases were middle-age and youth. 7 cases had basis diseases. 9 cases had no clinical symptoms, l0 cases had mild respiratory symptoms, such as cough, expectoration etc. All patients were documented by surgical operation, percutaneous puncture and transbronchial lung aspiration （TBLB）. Imaging manifestation of PC have three types： mass and nodule（n=16）, pneumonia-like change（n=7）, mix change （n=5）. PC clinical symptoms were relatively light for mass and nodule. The clinical symptoms of PC patients with basis diseases were relatively severe and their imaging manifestation most were pneumonia-like change and mix change. ConcIusion Clinical and imaging of PC has not any specific. For PC, we must think highly of its existence, study its characteristic and raise its diagnosis ability .It is suggested that the utilization of pereutaneous puncture and TBLB for PC diagnosis can decrease the rate of surgical operation.

关 键 词：肺隐球菌病 体层摄影术 X线计算机 医学影像学 诊断 临床特点 影像学分析 影像学表现 经纤支镜肺活检 呼吸道症状 

分 类 号：R519.4[医药卫生—内科学] R563.1[医药卫生—临床医学]