无免疫功能缺陷的肺隐球菌病19例误诊分析  

Misdiagnosis Analysis on 19 Cases of Non-immunodeficiency Pulmonary Cryptococcosis

作　　者：梅周芳[1] 秦欣宇 潘星月[2] 赵露[2] 杨雨萌[2] 印体平 施天昀 揭志军[1] 

机构地区：[1]复旦大学附属上海市第五人民医院呼吸内科,上海200240 [2]皖南医学院临床医学系,安徽芜湖241000

出　　处：《临床误诊误治》2016年第1期50-52,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨无免疫功能缺陷的肺隐球菌病临床特点及误诊原因。方法 回顾性分析我院2010年6月—2014年10月收治的19例无免疫功能缺陷的肺隐球菌病误诊病例资料。结果 本组以中青年男性为主,以咳嗽、发热、咳痰为主要表现,14例（73.7%）影像学表现为结节型肿块。入院初期误诊为肺结核6例（31.6%）,肺癌5例（26.3%）,普通细菌感染4例（21.1%）,误诊率达78.9%。均经病理检查确诊肺隐球菌病,其中经皮肺穿刺活组织病理检查确诊13例,术后病理检查确诊5例,气管镜肺活组织病理检查确诊1例。6例（31.6%）经外科手术切除,13例（68.4%）予氟康唑抗真菌治疗,效果满意,随访0.5~1年未发现病情复发或其他脏器播散。结论 肺隐球菌病在免疫功能正常人群中亦可发病;肺隐球菌病影像学表现形式多种多样,需与肺结核、肺癌及机化性肺炎相鉴别,病原学检查和肿块活组织病理检查对于鉴别诊断至关重要,尤其PAS染色诊断敏感性极高。Objective To discuss the clinical characteristics, diagnosis and treatment of patients with non immune deficiency pulmonary cryptococcosis. Methods A retrospective analysis was conducted on 19 cases of non immune deficiency pulmonary disease misdiagnosed in our hospital during June 2010 and October 2014. Results Most of the patients discussed were young males with cough, fever, productive cough as the main clinical symptoms, imaging manifestations mainly as mass and nodular type （14 cases, accounting for 73.7% ）. 6 cases （31.6%） , 5 cases （26.3%） , 4 cases （21.1%） were misdi- agnosed as pulmonary tuberculosis, the misdiagnosis rate was 78.9%. Percutaneous lung biopsy was performed in 13 cases, and 5 cases were confirmed by pathological examination after operation, and 1 case was confirmed by pathology. 6 cases （31.6%） underwent surgical treatment and 13 cases （68.4%） were treated with antifungal agents, and the results were sat- isfactory. The patients were followed up for 0.5 to 1 year. No recurrence of disease or spreading to other organs were reported. Conclusion Pulmonary tuberculosis may occur in people with normal immune system. The imaging manifestations of pulmo- nary tuberculosis patients are varied, and it is difficult to diagnose. It is necessary to identify with pulmonary tuberculosis and lung cancer. Therefore it needs to be confirmed by pathology and pathogenic examination. In particular, the sensitivity of PAS staining is very high.

关 键 词：肺疾病 隐球菌病 误诊 结核 肺 肺肿瘤 细菌感染 治疗 

分 类 号：R519.4[医药卫生—内科学]