新生隐球菌肺部感染的临床特征和4种检测方法性能评价  

Clinical characteristics of cases with cryptococcus neoformans pulmonary infection and performance evaluation of four detection methods

作　　者：邹盛华 方美兰 林珍丽 陈新朝 黄明翔 官红莲 王新航 ZOU Shenghua;FANG Meilan;LIN Zhenli;CHEN Xinchao;HUANG Mingxiang;GUAN Honglian;WANG Xinhang(Fuzhou Pulmonary Hospital,Fuzhou,Fujian 350008,China)

机构地区：[1]福州肺科医院,福建福州350008

出　　处：《海峡预防医学杂志》2021年第3期11-14,共4页Strait Journal of Preventive Medicine

基　　金：福建省临床重点专科建设项目(闽卫医政函[2018]145)。

摘　　要：目的分析新生隐球菌肺部感染的临床特征和微生物学检测方法,探讨其早期诊断方法。方法收集2017年1月至2019年12月真菌培养确诊新生隐球菌肺部感染患者47例、非隐球菌感染患者56例,收集病历资料和临床样本(肺穿刺物、痰液和支气管灌洗液等),样本用革兰染色、墨汁染色和隐球菌荚膜多糖检测试剂盒(LFA)等方法检测。结果47例新生隐球菌肺部感染患者均是非AIDS/HIV患者,其中8例为隐球菌脑膜炎患者。主要临床表现为咳嗽(59.6%),最常见的影像学表现为肺部结节(85.1%)、合并症为脂肪肝(27.7%);肺穿刺物样本检出率(真菌培养法78.7%、LFA法59.6%、墨汁染色法31.9%、革兰染色法19.1%)高于其他样本的检出率;以真菌培养为金标准,LFA、墨汁染色和革兰染色的敏感性为95.7%、44.7%和31.9%,特异性为98.2%、100.0%和96.4%,阳性预测值为97.8%、100.0%和88.2%,阴性预测值为96.5%、68.3%和62.8%。结论非AIDS/HIV的新生隐球菌肺部感染患者临床症状较轻;肺穿刺样本在4种检测方法中检出率最高;与传统检测方法比较,LFA具有早期、快速、敏感性和特异性较高等优势。Objective To analyze the clinical characteristics and microbiological detection methods of cases with cryptococcus neoformans pulmonary infection for exploring the early diagnosis methods of the infection.Methods Totally 47 cases with cryptococcus neoformans pulmonary infection by fungal culture and 56 cases without cryptococcal infection were collected from Jan.2017 to Dec.2019.The medical records and clinical samples(lung puncture,sputum and bronchial lavage fluid,etc.)of the patients were collected and the samples were detected by Gram staining,India ink staining and cryptococcal antigen lateral flow assay(LFA).Results Totally 47 cases diagnosed with cryptococcus neoformans pulmonary infection were non-AIDS patients.Eight patients of them were cryptococcal meningitis.The main clinical manifestation was cough(59.6%).The most common imaging findings were pulmonary nodules(85.1%)and complication with fatty liver(27.7%).The detection rates of lung puncture samples(78.7%for fungal culture method,59.6%for LFA method,31.9%for India ink staining method and 19.1%for Gram staining method)were higher than those of other samples.Taking Fungal culture as the gold standard method,the sensitivities of LFA,India ink staining and Gram staining were 95.7%,44.7%and 31.9%,and the specificities were 98.2%,100%and 96.4%,and the positive predictive values were 97.8%,100%and 88.2%and the negative predictive values were 96.5%,68.3%and 62.8%respectively.Conclusion Non-AIDS/HIV patients with cryptococcus neoformans pulmonary infection show mild clinical symptoms.The positive rate of four detection methods is the highest by using lung puncture samples.LFA method shows advantages of early,rapid,high sensitivity and specificity,comparing with traditional detection methods.

关 键 词：肺隐球菌病 新生隐球菌 非AIDS/HIV患者 胶体金免疫层析法 

分 类 号：R379.5[医药卫生—病原生物学]