非艾滋病患者不同免疫状态肺隐球菌病临床和CT表现对比分析  

Pulmonary crytococcosis in non-AIDS patients with different immunology conditions:comparison of clinical and CT characteristics

作　　者：陈相猛[1] 段晓蓓[2] 郝以秀 金志发[1] 崔恩铭[1] 龙晚生[1] 张朝桐[1] 柳学国[3] CHEN Xiang-meng DUAN Xiao-bei HAO Yi-xiu et al(Department of Radiology,the Affilated Jiangmen Hospital of Sun Yat-sen University,Guangdong 529070,Chin)

机构地区：[1]中山大学附属江门医院放射科,广东529070 [2]中山大学附属江门医院核医学科,广东529070 [3]中山大学附属第五医院放射科,广东519000

出　　处：《放射学实践》2016年第11期1047-1051,共5页Radiologic Practice

摘　　要：目的:分析非艾滋病(AIDS)患者不同免疫状态下肺隐球菌病(PC)的临床和CT表现的异同。方法:回顾性分析经临床证实的PC患者的临床和CT资料,分别对免疫低下和免疫正常PC患者的临床表现和胸部CT征象进行对比。结果:共收集49例非AIDS PC患者,包括免疫低下组24例和免疫正常组25例,平均年龄(51.8±12.5)岁。PC患者常见的临床症状为咳嗽和发热,免疫低下组均明显多于免疫正常组(P=0.015;P=0.028)。在病灶数量上,免疫低下组以多发为主15例(62.5%),免疫正常组以单发为主16例(64.0%),差异无统计学意义(P=0.064)。在CT征象上,免疫低下组表现为结节或肿块11例(45.8%),实变13例(54.2%),合并磨玻璃密度影7例(12.9%);而免疫正常组CT表现为结节或肿块21例(84.0%),实变4例(16.0%),合并磨玻璃影1例(4.0%),差异有统计学意义(P=0.005;P=0.023)。病变内部空洞形成率在免疫低下患者13例(54.2%)明显多于免疫正常患者6例(24.0%,P=0.030)。结论:咳嗽和发热更常见于非AIDS但免疫力低下的PC患者。非AIDS PC患者的影像学表现与免疫状态有关。免疫低下者以肺内多发、实变影为主,免疫正常者以肺内单发、结节/肿块影常见;空洞和磨玻璃密度影更容易发生在免疫低下患者。Objective：To analyze the clinical and CT characteristics in non-AIDS patients with pulmonary crytococcosis （PC） under different immune conditions. Methods： The clinical materials and CT images of clinically proven Non-AIDS patients with PC were reviewed respectively,comparison between immune-suppressed and immune-competent patients were performed. Results：A total of 49 patients （24 immune-suppressed and 25 immune-competent patients） were recruited,with the mean age as （51.8 ± 12.5）y. The common clinical symptoms were cough and fever, which displayed in immune-suppressed group were more than that of immune-competent group （P=0. 015,0. 028）. As for the number of lesions, multiple lesions were revealed in 15 patients of immune-suppressed group （62.5%） and solitary lesion in 16 patients of immunecompetent group （64.0%）, with no significant statistic difference （P： 0. 064）. AS for CT findings, nodules/masses were revealed in 11 patients （45.8%）,consolidations in 13 patients （54. 2%）,accompanied with ground-glass opacity in 7 patients （ 12.9 % ） of immune-suppressed group ; whereas, in immune-competent group, which were 21 patients （84.0 % ）, 4 pa- tients （16.0 %）, one patient （4.0 %）, respectively, with significant statistic difference （ P - 0. 005,0. 023 ）. Intra-lesional cavitation could be assessed in 13 patients （54.2 %） of immune-suppressed group, which was obviously more than that of the immune-competent group （6 patients, 24 % ）（P= 0. 030）. Conclusion：Cough and fever were more commonly seen in non- AIDS yet immune-suppressed PC patients. Imaging characteristics of non-AIDS patients with PC might be related to the immune status. Multiple lesions and consolidations were more frequently revealed in immune-suppressed group. Solitary and nodules/masses were more in immune-competent group. Cavitations and ground-glass opacity were more common common in immune-suppressed patients.

关 键 词：肺疾病 真菌性 肺隐球菌病 免疫 体层摄影术 X线计算机 

分 类 号：R519[医药卫生—内科学] R816.4[医药卫生—临床医学]