非HIV感染人群肺隐球菌病29例临床特征分析  

Pulmonary Cryptococcosis without Human Immunodeficiency Virus Infection:a Clinical Analysis of 29 cases

作　　者：郭玲玲[1] 周洪[1] 刘娜 GUO Ling-ling;ZHOU Hong;LIU Na(Department of Respiratory and Critical Care Medicine,Jiangxi Provincial People's Hospital,Nanchang 330006,China)

机构地区：[1]江西省人民医院呼吸与危重症医学科,南昌330006

出　　处：《实用临床医学（江西）》2024年第3期1-5,F0004,共6页Practical Clinical Medicine

基　　金：江西省卫健委科技计划(202210109)。

摘　　要：目的 总结非人类免疫缺陷病毒(HIV)感染人群肺隐球菌病的临床特点和诊治方法,提高临床医师对该病的认识和诊治水平。方法 回顾性分析2016—2021年江西省人民医院确诊的29例非HIV人群肺隐球菌病的临床资料,包括临床症状、实验室检查、肺部影像学资料及治疗、转归情况。结果 29例患者中男21例,女8例,中位年龄为56.5岁。基础疾病情况:肾移植术后5例(5/29),自身免疫系统疾病9例(9/29),糖尿病2(2/29),脾切除1例(1/29),无任何相关基础疾病12例(12/29)。首发症状常见为:咳嗽10例(10/29)、胸痛6例(6/29)、发热5例(5/29);肺部影像表现为结节肿块型19例,浸润型10例,混和型3例。29例患者气管镜灌洗液隐球菌荚膜多糖抗原检测阳性24例(24/29),外周血隐球菌荚膜多糖抗原阳性20例(20/29),脑脊液隐球菌荚膜多糖抗原阳性3例(3/29)。29例患者通过气管镜灌洗及活检确诊8例,手术切除确诊6例,经皮肺穿刺活组织检查确诊5例,另外10例通过血清学及治疗后随访临床确诊。29例患者均按照指南规范治疗,疗程6~12个月不等,治愈25例,失败4例(其中3例为免疫缺陷宿主,1例因经济原因放弃治疗)。结论 非HIV人群肺隐球菌病临床症状不典型,需重视血清学的隐球菌荚膜多糖抗原检测,必要时需要行电子气管镜、经皮肺穿刺等有创检查明确诊断,经过规范治疗大多数患者预后良好。Objective To summarize clinical features and diagnosis of pulmonary cryptococcosis in non-human immunodeficiency virus(non-HIV)population so as to improve clinicians'understanding and management of the disease.Methods The clinical data of 29 cases of pulmonary cryptococcosis in non-HIV population diagnosed in Jiangxi Provincial People's Hospital from 2016 to 2021 were retrospectively analyzed,including clinical symptoms,laboratory tests,lung imaging characteristics,treatment and prognosis.Results There were 21 males and 8 females among the 29 patients,with the median age 56.5 years.The underlying diseases were as followed:5 cases(5/29)with renal transplantation,9 cases(9/29)with autoimmune system diseases,2(2/29)with diabetes mellitus,1 case(1/29)with splenectomy,and 12 cases(12/29)without any associated underlying disease.The first symptoms were common:cough in 10 cases(10/29),chest pain in 6 cases(6/29),and fever in 5 cases(5/29);lung imaging showed nodular mass in 19 cases,with 10 cases of infiltrative type and 3 cases of mixed type.24 patients(24/29)tested positive for cryptococcal capsular polysaccharide antigen(CrAg)in bronchoscopic lavage fluid(BALF),20(20/29)positive for CrAg in peripheral blood,and 3(3/29)positive for CrAg in cerebrospinal fluid.Among the 29 patients,the diagnosis of 8 cases was confirmed by bronchoscopic lavage and biopsy,6 cases by surgical resection,5 cases by percutaneous lung biopsy;the other 10 cases were diagnosed by CrAg test and follow-up after treatment.All the 29 patients were treated according to the standardized guideline,with a course of treatment ranging from 6 to 12 months:25 cases were cured and 4 cases failed(3 of them were immunodeficient hosts,and 1 case gave up the treatment due to economic reasons).Conclusion There can be no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients.Serologic detection of CrAg may be considered by clinicians,and invasive tests such as electronic bronchoscopy and percutaneous lung puncture may be needed to

关 键 词：肺真菌病 隐球菌肺炎 非HIV人群 

分 类 号：R519[医药卫生—内科学]