45例非HIV感染者肺隐球菌病临床特征和CT分析  

Clinical features and CT analysis of 45 cases of pulmonary cryptococcosis in HIV-uninfected patients

作　　者：蔡仁慧[1] 王英[2] CAI Renhui;WANG Ying(Department of Dermatology,Shengli Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou University Affiliated Provincial Hospital,Fuzhou 350001,China;Department of Dermatology,Changhai Hospital,Second Military Medical University,Shanghai 200433,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院皮肤科,福州大学附属省立医院,福州350000 [2]上海长海医院皮肤科,上海200433

出　　处：《中国真菌学杂志》2024年第6期613-618,644,共7页Chinese Journal of Mycology

基　　金：福建省对外合作项目(2024I0032)。

摘　　要：目的本研究旨在探讨非HIV感染肺隐球菌病患者的临床特征和影像学特点,以减少漏诊和误诊。方法回顾性分析2021年1月—2023年12月在我院确诊的肺隐球菌病患者的临床与影像学资料。结果共纳入了45例非HIV感染肺隐球菌病患者,平均年龄(55.47±15.31)岁,其中男性22例。免疫功能低下组共16例,平均年龄(60.38±11.59)岁,显著高于29例免疫功能正常组的(33.34±9.53)岁(P<0.0001)。无症状者占42.22%(19例)。高分辨率计算机断层扫描显示,病变形态以单发结节为主(34/45例),病变部位以左肺下叶最多(22例,占48.89%),其次为右肺下叶(15例,占33.33%)和右肺上叶(11例,占24.44%)。经皮CT引导下肺穿刺组织病理学检查确诊阳性率为100%(15/15例)。肺组织隐球菌培养阳性率为70%(7/10例),高于肺泡灌洗液。结论非HIV感染肺隐球菌病的临床表现缺乏特异性,对于临床上高度怀疑的患者,推荐首选经皮CT引导下肺穿刺进行肺组织真菌培养和病理学检查。Objective This study aims to explore the clinical and radiological characteristics of non-HIV-infected patients with pulmonary cryptococcosis in order to reduce missed diagnosis and misdiagnosis.Methods The clinical and imaging data of patients with pulmonary cryptococcosis diagnosed in our hospital from January 2021 to December 2023 were retrospectively analyzed.Results A total of 45 non-HIV-infected pulmonary cryptococcosis patients were included,including 22 males with an average age of 55.47±15.31 years old.There were 16 patients in the immunocompromised group,with an average age of 60.38±11.59 years old,which was significantly higher than the 33.34±9.53 years old in the immunocompromised group(P<0.0001).Asymptomatic patients accounted for 42.22%(19 cases).High-resolution computed tomography(HRCT)showed that the lesions were mainly single nodules(34/45 cases),and the lesions were most frequently located in the lower lobe of the left lung(22 cases,accounting for 48.89%),followed by the lower lobe of the right lung.(15 cases,accounting for 33.33%)and the upper lobe of the right lung(11 cases,accounting for 24.44%).The positive rate of confirmed diagnosis by histopathological examination of lung puncture under percutaneous CT guidance was 100%(15/15 cases).The positive rate of cryptococcal culture in lung tissue was 70%(7/10 cases),which was higher than that in alveolar lavage fluid.Conclusion The clinical manifestations of non-HIV-infected pulmonary cryptococcosis lack specificity.For patients with high clinical suspicion,percutaneous CT-guided lung puncture for lung tissue fungal culture and pathological examination is recommended as the first choice.

关 键 词：肺隐球菌病 真菌感染 高分辨率CT 新生隐球菌 非HIV感染 

分 类 号：R519.4[医药卫生—内科学]