免疫健全与免疫缺损宿主肺隐球菌病临床对比分析  

Clinical findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients

作　　者：李宁[1] 李敏[1] 万欢英[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸科,上海200025

出　　处：《上海医学》2013年第1期38-42,共5页Shanghai Medical Journal

摘　　要：目的探讨不同免疫状态患者肺隐球菌病的临床特点。方法回顾性分析上海交通大学医学院附属瑞金医院2002年8月―2012年8月经病理学检查确诊为肺隐球菌病患者的临床资料。结果 39例患者中,入选免疫健全组20例,免疫缺损组19例。所有患者人类免疫缺陷病毒(HIV)抗体均为阴性。首发症状依次为咳嗽、咳痰和发热,其中13例(33.3%)无明显症状。免疫缺损组的CD3T淋巴细胞百分比显著低于免疫健全组(P=0.048)。影像学检查显示,免疫缺陷组的双肺弥漫混合性病变构成比显著高于免疫健全组(P=0.022)。11例患者行手术治疗,3例行手术联合抗真菌药物治疗,22例予抗真菌单药治疗,1例予氟康唑联合抗肿瘤治疗,2例未行治疗即出院。随访资料完整者27例,均获不同程度的症状改善及病灶吸收。结论肺隐球菌病可发生在免疫健全宿主,临床和影像学表现缺乏特异性,与患者的免疫状态有关。诊断主要依赖病理学检查。可根据不同患者的免疫状况进行治疗,预后良好。Objective To analyze the clinical manifestations, radiology, diagnosis and treatment of pulmonary cryptococcosis in patients under different immune states. Methods Retrospective analysis was performed about the clinical data of 39 patients confirmed by pathological examinations at Ruijin Hospital, Shanghai Jiaotong University School of Medicine from August 2002 to August 2012. Results Of the patients, 20 were immunocompetent and 19 were immunocompromised. All of the patients were non-Acquired Immune Deficiency Syndrome. The early symptoms were cough, phlegm and fever. Thirteen patients （33. 3%） remained asymptomatic. CD3 T cells percentage were significantly decreased （P = 0. 048） and diffuse mixed imaging was significantly increased （ P = 0. 022） in the immunocompromised patients as compared with the immunocompetent patients. There were no significant differences in other testing results between the two groups （P ~ 0. 05）. Surgical resection was performed in 11 cases, surgical treatment combined with antifungal drug therapy in 3, antifungal drug therapy in 22 cases, fluconazole combined with antitumor drug therapy in 1. Two cases were discharged without treatment. There were 27 patients with complete clinical data during follow up and the symptoms and the lesions were lessened in some extent. Conclusion Immunocompetent patients can suffer from pulmonary cryptococcosis. There are no specific clinical manifestations and image findings for pulmonary cryptococcosis. The disease is related to the immune status of patients. The diagnosis mainly relies on histopathological examination. More reasonable treatments should be adopted according to patients＇ immune status to achieve better prognosis.

关 键 词：肺 隐球菌病 免疫状态 临床表现 

分 类 号：R519[医药卫生—内科学]