非HIV感染的肺隐球菌病51例临床分析  

Clinical analysis of 51 cases of pulmonary cryptococcosis without HIV infection

作　　者：宋永春 史会影 方翔[2] 孙芳[2] 汤兵祥[2] Song Yongchun;Shi Huiying;Fang Xiang;Sun Fang;Tang Bingxiang(Department of Respiratory,the First Affiliated Hospital of Zhengzhou University,Zhengzhou450000,China;The Chest Hospital of Henan Province,Zhengzhou450000,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,河南郑州450000 [2]河南省胸科医院,河南郑州450000

出　　处：《河南医学研究》2018年第23期4250-4254,共5页Henan Medical Research

摘　　要：目的分析肺隐球菌病的临床特点和治疗方案。方法回顾分析2014年1月至2017年12月在郑州大学第一附属医院确诊的51例肺隐球菌病患者的临床资料,51例均为非HIV感染。根据免疫状态分为免疫功能正常组与免疫功能受损组,对比两组临床表现、影像学和实验室指标。结果 51例患者中男28例,女23例,年龄4～81岁,平均(46. 3±14. 5)岁。免疫功能正常组18例,免疫功能受损组33例,两组在咳嗽、咳痰临床表现方面比较,差异无统计学意义(P> 0. 05);两组在发热临床表现方面比较,差异有统计学意义(P <0. 05)。肺隐球菌病影像学表现无特异性,结节肿块型占56. 9%、混合型占21. 6%、浸润型占21. 6,两组在三者表现上比较,差异无统计学意义(P> 0. 05),伴随征象主要有晕征28例(54. 9%),纵膈淋巴结肿大16例(31. 4%)。初步诊断中有28例(54. 9%)被误诊为肺癌。两组C-反应蛋白(CRP)、降钙素原(PCT)、D-二聚体水平比较,差异有统计学意义(P <0. 05)。51例患者均为病理诊断,其中CT引导下肺穿刺取病理其阳性率为97. 9%(46/47)。51例患者药物治疗46例,治疗有效率为95. 7%(44/46),单独接受氟康唑治疗的有效率为85. 2%(23/27)。结论肺隐球菌病临床表现无特异性,合并免疫功能受损的肺隐球菌病常以发热为主要表现;常用的抗真菌药物对肺隐球菌病治疗效果较好。Objective To investigate the clinical features and treatment of pulmonary cryptococcosis.Methods A total of51cases of pulmonary cryptococcosis without HIV infection confirmed by pathological examinations from January of2014to December of2017in the first affiliated hospital of Zhengzhou university were studied.The patients were divided into the non-immunocompromised hosts and immunocompromised hosts according to the immune status.The clinical manifestations,imaging and laboratory indexs were compared between two groups.Results The patients consisted of28males and23females,with a mean age of(46.3±14.5)years(range4to81years).Eighteen cases were non-immunocompromised hosts and thirty-three cases were immunocompromised hosts.There was no statistically significant difference between the two groups in the clinical manifestations of cough and sputum coughing(P>0.05).There was significant difference in the clinical manifestation of fever(P<0.05).Pulmonary cryptococcosis imaging also showed no specificity,nodular or mass^like shadows in56.9%,mixed lesions in21.6%and patchy infiltrates or consolidation in21.6%,there were no statistically significant differences between the two groups(P<0.05).Radiographic sign with halo sign was28(54.9%)cases,16(31.4%)cases of mediastinal lymphadenopathy.In the initial diagnosis,28(54.9%)cases were misdiagnosed as lung cancer.There were differences in C-reactive protein(CRP),procalcitonin(PCT)and D-polymer in the two groups(P<0.05).The diagnosis was confirmed in all cases by pathological findings.The positive rate of CT guided lung puncture was97.9%(46/47).Forty-six of the51patients were treated with drugs,and the effective rate was44/46(95.7%).The curative rate of fluconazole was23/27(85.2%).Conclusion Pulmonary cryptococcosis has no specificity in clinical manifestations.When immune function is impaired,fever maybe is the mainly reflected.The commonly used of antifungal drugs have better effect on pulmonary cryptococcosis.

关 键 词：肺隐球菌病 真菌 治疗 影像学表现 

分 类 号：R563[医药卫生—呼吸系统]