非免疫抑制的肺隐球菌病7例临床分析及文献复习  

Clinical analysis of 7 cases non-immune suppression of pulmonary cryptococcosis and literature review

作　　者：刘华[1] 王菲[1] 汤志远[1] 陶一江[2] 

机构地区：[1]南通大学附属医院呼吸科,南通226001 [2]江苏省南通市第一人民医院呼吸科

出　　处：《南通大学学报（医学版）》2015年第6期514-517,F0003,共5页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(30971306);国家自然科学基金青年基金资助项目(81503143)

摘　　要：目的 ：提高临床医师对非免疫抑制的肺隐球菌病的认识。方法 ：回顾性分析南通大学附属医院及南通市第一人民医院2010年1月—2015年2月经B超引导下肺穿刺活检或手术病理证实,以及乳胶凝集试验诊断为肺隐球菌病患者的临床表现、实验室检查、影像学检查、病理诊断及治疗等资料。结果：本组病例共7例,男5例,女2例;年龄33-66岁,平均52.4岁;5例伴有基础疾病;所有患者均人类免疫缺陷病毒阴性,均未行器官移植。胸部CT扫描表现为多发磨玻璃灶和结节1例;多发或单发的肺部结节和（或）肿块6例,其中1例患者在病程中部分有实变及空洞形成。2例行胸腔镜手术切除治疗,经手术病理证实,3例经B超引导下经皮肺穿刺活检病理证实,2例通过乳胶凝集试验诊断。7例患者均予氟康唑治疗6-12个月,随访8个月-2年,肺部病灶均有不同程度吸收,1例右肺多发病灶经胸腔镜行右下肺切除术的患者,随访21个月后,再次行右上肺病灶切除术切除治疗。结论：肺隐球菌病临床表现无特异性,胸部CT扫描多表现为多发或单发结节和（或）肿块;经皮肺活检及乳胶凝集试验为诊断肺隐球菌病的重要手段;氟康唑治疗肺隐球菌病效果可,需提防氟康唑耐药菌株的产生。Objective： To improve the understanding of non-immune suppression of patients with pulmonary cryptococcosis for clinical doctors. Methods： A total of 7 cases of pulmonary cryptococcosis, diagnosed at Hospital Affiliated to Nantong University and Nantong First People＇s Hospital from January 2010 to February 2015, identified by pathological examinations or Latex agglutination test, were retrospectively studied. Results： The patients consisted of 5 males and 2 females aged from33 to 66 years. Pulmonary nodules, either solitary or multiple, present in 6 of the 7 cases in CT finding. The diagnosis was confirmed in all cases by pathological study or latex agglutination test. The lung specimens of 3 cases were obtained by ultrasound guided transthoracic needle aspiration lung biopsy, 2 cases were treated by surgical operation and pathology, and 2cases were diagnosed by latex agglutination test. These 7 cases were treated with fluconazole for 6-12 months, after 8-24 months of follow-up, the pulmonary lesion were absorbed in different degrees. Conclusion： Most pulmonary cryptococcosis presented as pulmonary nodules or masses on CT, either solitary or multiple. An important method for the diagnosis of pulmonary cryptococcosis by percutaneous lung biopsy and latex agglutination test. Fluconazole is active against cryptococcus neoformans, and appears to be effective in the treatment. However, it should take into account the drug resistance of cryptococcus neoformans.

关 键 词：肺隐球菌病 隐球菌 经皮肺穿刺活检 乳胶凝集试验 

分 类 号：R563.9[医药卫生—呼吸系统]