不同免疫状态下肺隐球菌感染25例临床分析  

Clinical analysis of pulmonary cryptococci infection in 25 patients with varied immune states

作　　者：窦丽阳[1] 许文兵[2] 施举红[2] 刘鸿瑞[3] 冯瑞娥[3] 王澎[4] 严晓伟[5] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院呼吸科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院病理科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院检验科,北京100730 [5]中国医学科学院北京协和医学院北京协和医院心内科,北京100730

出　　处：《中国实用内科杂志》2010年第8期732-735,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析不同免疫状态下肺隐球菌感染(PC)的临床表现,治疗及随诊。方法回顾性分析2001年1月至2009年6月北京协和医院确诊为PC患者的临床资料。结果确诊为PC共25例,其中免疫正常15例,免疫缺损(ICH)10例。咳嗽13例(52%)为最常见的临床表现,免疫正常组8例(53.3%),ICH组5例(50%);仍有8例(32%)无症状患者。结节影21例(84%)为最常见影像学改变,免疫正常组13例(86.7%),ICH组3例(80%)。根据不同免疫状态接受治疗,5例(33.3%)免疫正常者进行手术治疗;免疫正常组5例与ICH组3例采用手术联合氟康唑方案;单用药物治疗方案,免疫正常组5例,ICH组7例。免疫正常组14例(93.3%)患者症状改善及病灶消失多于ICH组5例(50%)(P=0.023);ICH组2例发展为隐球菌血症死亡。结论 PC发病隐匿;临床及影像学不特异,诊断依赖病原学及病理检查。治疗应根据不同患者的免疫状况采用合理的方法,免疫功能正常的PC患者预后良好。Objective To analyze the clinical manifestations, treatment and follow-up visits of pulmonary cryptococcosis in patients under different immune states. Methods Retrospective analysis was performed on the clinical data in patients with physician-diagnosed pulmonary cryptococcosis in Peking Union Medical College Hospital from Jan 2001 to Jun 2009. Results 25 patients had a confirmed diagnosis, of whom 15 were immunocompetent and 10 were immunocompromised. Cough was the most common clinical symptom and was present in 13 subjects （52%） ,8 （53.3%） in immunocompetent group and 5 （50%） in immunocompromised group. There were 8 patients （32%） who remained asymptomatie,5 （33.3%） and 3 （30%） in the immunocompromised group. Pulmonary nodules were the most frequent radiological abnormality and were present in 21 patients （ 84% ） , 13 （86.7%） in immunocompetent group and 3 （80%） in the immunocompromised group. All the subjects received treatments according to their immune status. Surgical resection alone was performed in 5 immunocompetent patients （33.3 % ）, surgical resection-fluconazole combination therapy was adopted in 5 immunoeompetent subjects and 3 immunocompromised subjects, and antifungal single therapy was adopted in 5 immunocompetent subjects and 7 immunocompromised subjects. There were more subjects with improvement in symptoms and resolution of lesions in immunocompetent （14 cases, 93.3% ） group compared with immunocompromised group （5 eases, 50% ） （P = 0. 023 ）. Two immunocompromised subjects died of cryptoeoccal fungemia. Conclusion The pathogenesis of pulmonary cryptoeoecosis proved to be insidious. Due to its nonspecific clinical and radiographic characteristics, the diagnosis depends on pathogenic and pathologic examinations. More reasonable treatments of pulmonary cryptoeoecosis should be adopted according to patients＇ immune status, and better prognosis seems to be in favor of immunocompetent subjects.

关 键 词：肺隐球菌病 免疫正常 免疫缺损 抗真菌治疗 

分 类 号：R5[医药卫生—内科学]