健康人群隐球菌肺病临床特征探讨  

Clinical features of Pulmonary crypotocosis in immunocompetent patient

作　　者：蒲蓉[1] 李为民[1] 

机构地区：[1]四川大学华西医院呼吸科,四川成都610041

出　　处：《西部医学》2009年第9期1492-1493,1496,共3页Medical Journal of West China

摘　　要：目的探讨健康人群隐球茵肺病临床特征。方法回顾性分析四川大学华西医院2003年4月～2009年4月确诊的9例隐球菌肺病患者的临床资料。结果9例患者中男性7例，女性2例，年龄26~72岁，平均49岁。其中56％无基础疾病，HIV抗体均阴性，44％无明显临床症状，56％有下例临床表现：干咳3例，低熟1例，盗汗1例，胸痛2例，头痛1例。影像学表现：表现为结节或块影有7例；表现为纤维结节影有2例。病理学表现：9例均为肉芽肿性病变，7例查见多核巨细胞中有隐球茵芽生酵母细胞，余2例表现为慢性肉芽肿性炎伴片状坏死及纤维化，痰涂片检查均为阴性。结论隐球茵肺病多发生在健康状况较好的中青年男性，临床症状与影像学表现不相称，需要早期通过经皮肺活检或支气管镜检查取得肺部活组织进行病理学检查确诊，采用抗真菌药物治疗预后好。Objective The purpose of this study is to analyze the clinical features of pulmonary crypotocosis in immunocompetent patients. Methods A total of nine eases of pulmonary crypotoeosis （PC） diagnosed at West China Hospital of Sichuan University from Feb. 2003 to Feb. 2009 were retrospectively analyzed. All cases were identified by pathological study. Results The patients consisted of 7 males and 2 females, with average age of 49 years （26 to 72 year）, 56% of whom without underlying diseases and with normal immune function. Five patients （44%） were asymptomatie, and four patients （44%） had respiratory and/or constitutional symptoms. The most common symptoms were dry cough （33% ）, low-grade fever （11% ）, night sweet （ 11% ）, chest pain（22% ）, and headache（11% ） ;The common image features were nodule and mass, either solitary or multiple（ 78%）, fibronodule （22 %）. Non caseous granuloma was the main character in pathological study（100%）, in which 78% with multinucleated giant cells containing aboundant vacuolus yeast forms,and 22%with necrosis and/or fibrosis. The special staining with periodic acid Schiff （PAS） and Grocott Gomori ＂s methenamine silver （GMS） expressed positive. Non case was found Cryptococcus neoformans spores in sputum smear. Conclusions Some immunocompetent healthy people such as the young and the adult, may be compromised with PC. The symptoms and the imaging appearance was not accordance. Thus, the early adoption of percutaneous lung biopsy or bronchoscopy to obtain lung biopsy for pathological diagnosis was necessary. Finally, antifungus treatment for pulmonary cryptococcosis was effective.

关 键 词：健康人群 隐球菌肺病 临床特征 

分 类 号：R563.9[医药卫生—呼吸系统]