肺隐球菌病在有无症状时的临床及CT影像学特征分析  

Analysis of Clinical and CT Imaging Features of Patients with Pulmonary Cryptococcosis with or without Symptoms

作　　者：刘文娟 穆乃外尔·萨比尔 贾鹏[2] 汪诚[1] LIU Wen-juan;MUNAIWAIER-Sabier;JIA Peng;WANG Cheng(Department of Respiratory,Mingji Hospital Afliated to Nanjing Medical University,Nanjing 210000,Jiangsu Province,China;Department of Radiology,Mingji Hospital Affliated to Nanjing Medical University,Nanjing 210000,Jiangsu Province,China)

机构地区：[1]南京医科大学附属明基医院呼吸科,江苏南京210000 [2]南京医科大学附属明基医院放射科,江苏南京210000

出　　处：《中国CT和MRI杂志》2025年第2期83-85,共3页Chinese Journal of CT and MRI

基　　金：江苏省卫生健康委医学科研立项项目(ZDXKA2021229)。

摘　　要：目的分析肺隐球菌病(PC)患者在有无症状时的临床及CT影像学特征,以减少漏诊和误诊的发生。方法收集2019年1月至2023年9月我院诊治的20例PC患者的临床资料,按是否有症状分组,对其临床及CT影像学特征进行分析。结果20例PC患者中,男性11例,女性9例,年龄(48±13)岁。20例患者7例未出现明显临床症状(无症状组),在健康体检时发现;其余13例有临床症状(有症状组),临床表现较轻,主要为咳嗽、咳痰、发热、胸痛。有症状组中肺部CT病变显示病变类型多发病变为多,斑片影及实变影较无症状组多见,差异有统计学意义(P<0.05)。有症状组C-反应蛋白(CRP)、中性粒细胞百分比(Neu%)、中性粒细胞与淋巴细胞计数比值(NLR)均高于无症状组,淋巴细胞计数(LY)、淋巴细胞百分比(LY%)均低于无症状组,差异均有统计学意义(P<0.05)。结论PC患者的CT表现存在一定的特征性,有症状PC患者CT影像学主要以多发、实变影、斑片影为主,单发结节肿块型病例通常无症状,多因体检发现就诊。PC病变常伴有晕征、支气管充气征及蘑菇兄弟征,大多结节肿块位于胸膜下,单发结节或肿块容易误诊为肺癌,多发结节呈聚集生长,形似“蘑菇兄弟征”。Objective To analyze the clinical and CT imaging features of patients with pulmonary cryptococcosis(PC)with or without symptoms,and reduce the occurrence of missed diagnosis and misdiagnosis.Methods The clinical data of 20 patients diagnosed and treated with PC in our hospital from January 2019 to September 2023 were collected.The patients were grouped according to whether they had symptoms,and their clinical and CT imaging features were analyzed.Results Among the 20 PC patients,11 were male and 9 were female,with an average age of(48±13)years.7 of the 20 patients had no obvious clinical symptoms(asymptomatic group)and were found during physical examination.The remaining 13 patients had clinical symptoms(symptomatic group),and the clinical manifestations were mild,mainly cough,sputum,fever,and chest pain.The lung CT lesions in the symptomatic group showed that the types of lesions were more frequent,and the patchy shadows and consolidation shadows were more common than those in the asymptomatic group,and the difference was statistically significant(P<0.05).The C-reactive protein(CRP),neutrophil percentage(Neu%)and neutrophil to lymphocyte ratio(NLR)in the symptomatic group were higher than those in the asymptomatic group,and the lymphocyte count(LY)and lymphocyte percentage(LY%)were lower than those in the asymptomatic group,the differences were statistically significant(P<0.05).Conclusion The CT manifestations of PC patients have certain characteristics.The CT imaging of symptomatic PC patients is mainly multiple,consolidation and patchy shadows.Single nodular mass cases are usually asymptomatic,and most of them are found by physical examination.PC lesions are often accompanied by halo sign,bronchial inflation sign and mushroom brother sign.Most of the nodular masses are located under the pleura.Single nodules or masses are easily misdiagnosed as lung cancer.Multiple nodules show aggregated growth and are similar to'mushroom brother sign'.

关 键 词：肺隐球菌病 临床特征 CT征象 

分 类 号：R519.4[医药卫生—内科学]