不同免疫状态患者肺隐球菌病的临床特点分析  

Clinical features of pulmonary cryptococcosis in patients under different immune status

作　　者：曾能永[1] 徐云欢 孔晋亮[2] 彭玲[2] 巫艳彬[2] 蔡双启[2] 卢桦松 

机构地区：[1]钦州市第二人民医院呼吸内科,广西钦州535000 [2]广西医科大学第一附属医院呼吸内科,广西南宁530021

出　　处：《中华医院感染学杂志》2016年第10期2223-2226,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81260663);广西自然科学基金资助项目(2013GXNSFAA019166)

摘　　要：目的了解肺隐球菌病在不同免疫状态下的临床特点,以提高临床医师对肺隐球菌病的认知水平,减少误诊漏诊。方法回顾性分析医院2008年4月-2014年6月40例肺隐球菌病患者的临床资料,将40例患者分为免疫抑制组和免疫正常组,免疫抑制组21例、免疫正常组19例;对比两组患者在不同免疫状态下的临床特点;使用SPSS18.0软件进行数据处理和统计分析。结果 40例患者中有临床症状33例,主要症状依次为咳嗽、咳痰、胸痛、发热,其余7例无任何症状;胸部CT影像病变主要分布于肺外带24例,肺下叶19例;病变形态呈结节团块型的免疫正常组14例,免疫抑制组7例;病变表现为肺炎型的免疫正常组2例,免疫抑制组8例,混合型的免疫正常组3例,免疫抑制组6例;病变累及胸膜的免疫正常组14例,免疫抑制组17例。结论不同免疫状态肺隐球菌病患者的临床特点无特异性,病变多位于肺外带、肺下叶并累及胸膜,免疫正常CT表现多为局限的结节团块型,而免疫抑制宿主主要表现为肺炎型和混合型。OBJECTIVE To investigate the clinical features of pulmonary cryptococcosis in patients under different immune status so as to improve the clinician′s cognition of pulmonary cryptococcosis and reduce the misdiagnosis rate.METHODS The clinical data of 40 patients with pulmonary cryptococcosis who were treated in the hospital from Apr 2008 to Jun 2014 were retrospectively analyzed,the enrolled patients were divided into the normal immune function group with 19 cases and the immunosuppression group with 21 cases.The clinical features were observed and compared between the two groups of patients,and the statistical analysis of data was performed with the use of SPSS18.0software.RESULTS Of the 40 patients,33had clinical symptoms,the most common presenting symptoms were cough,expectoration,chest pain,and fever;the rest of 7cases did not have any symptom.The computed tomography（CT）findings of chest showed that most lesions were located in the peripheral lobes（24cases）and lower lobes（19cases）;there were 14 patients with nodular masses of lesions in the normal immune function group and 7cases in the immunosuppression group.There were 2patients with pneumonia in the normal immune function group and 8patients in the immunosuppression group;there were 3patients with mixed types of lesions in the normal immune function group and 6patients in the immunosuppression group.There were14 patients with lesion involved pleura in the normal immune function group and 17 patients in the immunosuppression group.CONCLUSIONThe clinical features of the patients with pulmonary cryptococcosis are not specific under different immune status,the lesions mainly locate in the peripheral lobes,lower lobes,and involved pleura.The CT findings show that the lesions of the patients with normal immune function are mainly characterized by nodular masses shadow,while the lesions of the immunosuppressed hosts are mainly characterized by pneumonia type and mixed type.

关 键 词：肺隐球菌病 免疫正常 免疫抑制 临床特点 

分 类 号：R379.6[医药卫生—病原生物学]