57例免疫功能正常肺隐球菌病临床特征  

Clinical characteristics of 57 pulmonary cryptococcosis patients with normal immune function

作　　者：雷莉莉[1] 张宇[2] 邹珏[3] 徐春华[4] 李春梅[5] LEI Li-li;ZHANG Yu;ZOU Jue;XU Chun-hua;LI Chun-mei(Nanjing Chest Hospital Affiliatedto Southeast University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京市胸科医院感染管理科,江苏南京210029 [2]南京市胸科医院呼吸科,江苏南京210029 [3]南京市胸科医院病理科,江苏南京210029 [4]南京市胸科医院内镜中心,江苏南京210029 [5]南京市胸科医院微生物室,江苏南京210029

出　　处：《中华医院感染学杂志》2021年第13期1941-1945,共5页Chinese Journal of Nosocomiology

基　　金：江苏省卫计委医学科研基金资助项目(H2018030)。

摘　　要：目的分析57例免疫功能正常肺隐球菌病临床特征。方法回顾性分析2012年1月-2019年12月南京市胸科医院诊断为肺隐球菌病的57例免疫功能正常患者的临床病史和症状、实验室检查、影像学表现及诊断治疗过程。结果肺隐球菌病患者年龄分布21-75岁,男女比例为1.85∶1,感染部位分布左肺15例,右肺21例,两肺均存在21例(其中合并脑膜炎者3例,血液感染1例)。临床病史:体检中发现22例;主诉咳嗽25例,其中包括咳嗽伴胸痛5例;发热6例;头晕呕吐、头痛2例;痰血1例;气喘1例。43例作隐球菌多糖荚膜抗原乳胶凝集试验(LA)患者中阳性30例,阴性13例。经病理诊断共37例:其中15例经手术明确诊断,22例经肺穿刺/活检明确诊断。影像以肺结节为主26例,以肺斑片影为主16例,以占位性病灶为主8例,空洞影7例。治疗大部分应用氟康唑0.4 g, 1/d,外科术后多用0.2 g, 1/d,病情稳定。结论对于免疫功能正常、临床症状轻微、影像学异常患者,需警惕肺隐球菌病,尽早获取组织病理明确诊断,并应结合临床表现、影像学及血清LA试验综合判定以制定治疗方案。OBJECTIVE To analyze the clinical characteristics of 57 pulmonary cryptococcosis patients with normal immune function. METHODS A total of 57 pulmonary cryptococcosis patients with normal immune function who were treated in Nanjing Chest Hospital Affiliated to Southeast University from Jan 2012 to Dec 2019 were enrolled in the study. The clinical data, laboratory test indexes, imaging findings and treatment and diagnosis processes were retrospectively analyzed. RESULTS The age of the pulmonary cryptococcosis patients ranged between 21 and 75 years old, the ratio of males to females was 1.85∶1. There were 15 cases with left lung infection, 21 cases with right lung infection and 21 cases of both lungs infection( 3 of whom were complicated with meningitis, 1 was complicated with bloodstream infection). The clinical data showed that 22 cases were found through physical examination, and 25 cases of cough were reported, including 5 cases of cough complicated with chest pain, 6 cases of fever, 2 cases of dizziness, vomiting and headache, 1 case of phlegm and blood and 1 case of asthma. Cryptococcus polysaccharide capsule antigen latex agglutination(LA) test was carried out for the 43 patients and showed that 30 were tested positive, and 13 were tested negative. Totally 37 patients were diagnosed through pathology, 15 of whom were confirmed with surgery, and 22 were confirmed with lung puncture or biopsy. The imaging findings showed that 26 patients had pulmonary nodules, 16 of whom had lung patch shadows, with 8 cases of space-occupying lesions and 7 cases of hollow shadows. Most of the patients were treated with 0.4 g of fluconazole for 1/d and 0.2 g after surgery, 1/d, with the illness condition stable. CONCLUSION For the patients with normal immune function, mild clinical symptoms and abnormal imaging findings, it is necessary to carry out the pathological examination as early as possible and develop the treatment program based on clinical manifestations, imaging findings and serum LA test.

关 键 词：肺隐球菌病 诊断 治疗 免疫功能正常 

分 类 号：R519.4[医药卫生—内科学]