不同免疫状态下肺隐球菌病临床特点及误诊误治分析  

Clinical characteristics,misdiagnosis and mistreatment of pulmonary cryptococcosis in different immune states

作　　者：朱锦琪 赵素娥 Zhu Jinqi;Zhao Su'e(Respiratory Diagnosis and Treatment Center,Changsha Central Hospital Affiliated to Nanhua University,Hunan Changsha 410004)

机构地区：[1]南华大学附属长沙市中心医院呼吸病诊疗中心,湖南长沙410004

出　　处：《中国社区医师》2020年第20期33-35,共3页Chinese Community Doctors

摘　　要：目的:探讨不同免疫状态下肺隐球菌病患者的临床特点及误诊误治情况。方法:选取2016年4月-2019年12月非人类免疫缺陷病毒(HIV)感染肺隐球菌病患者33例,按基础疾病或宿主因素分为免疫正常组24例和免疫低下组9例。比较两组患者不同免疫状态下的临床资料和误诊误治情况。结果:两组患者常见临床表现依次为咳嗽、咳痰、发热、胸痛等。免疫低下组中性粒细胞百分比和血沉水平高于免疫正常组,嗜酸性粒细胞百分比低于免疫正常组,差异有统计学意义(P<0.05)。胸部CT显示两组均累及右肺下叶多见,以结节肿块型、斑片实变和空洞型多见。初诊共误诊17例,误诊率高达51.5%;其中,免疫低下组4例误诊为肺结核,误诊为细菌性肺炎1例;免疫正常组误诊为肺结核4例,误诊为细菌性肺炎和肺脓肿8例。结论:无基础疾病者患肺隐球菌病日益增多,初诊误诊率高。外周血嗜酸性粒细胞增多对免疫功能正常患者可能有提示价值,高度怀疑的患者建议首选经皮肺穿刺活体组织检查,以减少误诊。Objective:To explore the clinical characteristics,misdiagnosis and mistreatment of pulmonary cryptococcosis in different immune states.Methods:From April 2016 to December 2019,33 cases of non HIV infected patients with pulmonary cryptococcosis were selected.According to basic diseases or host factors,they were divided into the normal immune group(24 cases) and the hypoimmune group(9 cases).We compared the clinical data,misdiagnosis and mistreatment of the two groups in different immune states.Results:The common clinical manifestations of the two groups were cough,expectoration,fever,chest pain and so on.In the hypoimmune group,the percentage of neutrophils and ESR were higher than those in the normal immune group,and the percentage of eosinophils was lower than those in the normal immune group,the difference was statistically significant(P<0.05).Chest CT showed that the right lower lobe of lung was involved in both groups,most of which were nodular mass type, spot consolidation type and cavity type.17 cases were misdiagnosed in the first diagnosis,the misdiagnosis rate was as high as 51.5%.In the hypoimmune group,4 cases were misdiagnosed as tuberculosis and 1 case was misdiagnosed as bacterial pneumonia.In the normal immune group,4 cases were misdiagnosed as tuberculosis and 8 cases were misdiagnosed as bacterial pneumonia and pulmonary abscess.Conclusion:The incidence of pulmonary cryptococcosis is increasing in people without basic diseases and the misdiagnosis rate is high.The increase of eosinophils in peripheral blood may be helpful for patients with normal immune function,in order to reduce misdiagnosis,percutaneous lung biopsy is recommended for patients with high suspicion.

关 键 词：肺隐球菌病 免疫状态 误诊 

分 类 号：R519.4[医药卫生—内科学]