摘要
目的：探讨肺隐球菌病（pulmonary cryptococcosis,PC）患者的临床特征.方法：回顾分析复旦大学附属中山医院2004年10月-2012年10月确诊的94例PC患者的临床特点、影像学表现、实验室检查、诊断和治疗.结果：94例PC患者中,男性62例,女性32例;年龄18～78岁,平均年龄（46.2±14.4）岁.临床主要表现为咳嗽50例（53.2％）、咳痰41例（43.6％）、发热20例（21.3％）、胸痛15例（16.0％）、气急10例（10.6％）、咯血7例（7.4％）等.影像学显示,以下肺受累多见,60例（63.8％）表现为单发和（或）多发结节,17例（18.1％）表现为渗出实变影,27例（28.7％）表现为混合病灶.94例中,经皮肺穿刺活检确诊48例（51.1％）,经支气管镜肺活检确诊17例（18.1％）,胸腔镜手术确诊24例（25.5％）,开胸手术确诊1例（1.1％）;经组织学培养确诊4例（4.3％）.54例患者行乳胶凝集试验检查,阳性率98.1％（53/54）.接受手术治疗的28例患者中,24例得到随访,随访1～3年,术后1年复发1例;接受单纯抗真菌治疗的66例患者中,59例得到随访,随访时间1～3年,40例治愈,12例病灶明显吸收、3例病灶无变化、2例恶化、1例病死、1例2年后复发.结论：PC影像学表现为病灶多发且以肺下部受累多见,临床表现无特异性,乳胶凝集试验敏感性高,经皮肺穿刺及经支气管镜肺活检有利于该病诊断.
Objective：To investigate the clinical characteristics of pulmonary cryptococcosis（PC）.Methods：Clinical features,imaging findings,laboratory tests,diagnosis and treatment of 94 cases of PC diagnosed at Zhongshan Hospital,Fudan University from October 2004 to October 2012 were retrospectively analyzed.Results：A total of 94 PC patients consisted of 62 males and 32 females,with an average age of （46.2 ± 14.4） years ranged from 18 to 78 years.In atypical clinical symptoms,the initial symptoms were cough （50,53.2 ％）,expectoration（41,43.6 ％）,fever （20,21.3 ％）,chest pain （15,16.0 ％）,tchypne （10,10.6％） and hemoptysis（7,7.4％）.The imaging features showed that the lower lobes of lung were most commonly involved; 60 cases （63.8 ％） showed single and multiple nodules,1 7 cases （18.1％） showed infiltration and consolidation,and 27 cases （28.7 ％） showed mixed lesions.Among the 94 cases,48 cases （51.1％） were diagnosed through percutaneous needle biopsy,17 cases （18.1％） through bronchoscopy biopsy,24 cases （25.5％） through thoracoscopic surgery,1 case （1.1％） through thoracotomy,and 4 cases （4.3 ％） through histological culture.During the followed-up of one to three years,there was one case with recurrence in one year in 24 cases.A total of 54 patients underwent latex agglutination test for pulmonary cryptococcosis,with a positive rate of 98.1％.Among the 28 patients undergoing surgery,24 cases have been follwed up for 1 to 3 years,and 1 cases recurred at 1 year after the operation.Among the 66 cases receiving antifungal therapy alone,59 cases have been followed up for 1 to 3 yuear; 40 cases were cured,12 cases showed remarkable absorption of focuses,2 cases grew worse,1 case was dead and 1 case recurred 2 years later.Conclusions：PC have imaging features of multiple lesions,commonly involving lower lobes of lungs,and patients have no specific clinical manifestations.Latex agglutination test have a high sensitivity in the diagnosis of P
出处
《中国临床医学》
2013年第5期644-647,共4页
Chinese Journal of Clinical Medicine
基金
国家自然科学基金项目(编号:30772019)
浙江省金华市科学技术局社发重点计划项目(编号:2011-3-002)
关键词
肺隐球菌病
临床特征
影像学
诊断
Pulmonary cryptococcosis
Clinical characteristics
Imaging
Diagnosis
