摘要
目的 分析肺隐球菌病的临床表现及影像学特点,提高临床医生对本病的认识.方法 对2001年1月至2013年3月南京军区南京总医院、宿迁市人民医院、解放军第八一医院确诊的肺隐球菌病患者的临床表现、影像学特征、实验室检查、治疗及预后等进行回顾性分析.结果 共收集65例确诊肺隐球菌病病例,其中男44例,女21例,年龄12～73岁,平均（44±13）岁.常见的临床症状有咳嗽32例,咳痰20例,发热16例,胸痛14例,另有18例患者无症状.常见胸部影像学表现有单发或多发肿块或结节影（36例）、斑片状浸润影（19例）及混合病变（10例）.21例行隐球菌荚膜多糖抗原检测,14例阳性.抗原滴度（≥1：8为阳性）与疾病严重程度及影像学病变范围呈正相关.经皮肺穿刺活检确诊45例,经TBLB确诊3例,经手术确诊17例.65例患者中,经急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分者53例,评分＜10分者45例,其中完全或部分缓解38例,进展4例,死亡3例;评分≥10分者8例,其中完全或部分缓解3例,进展1例,死亡4例.结论 肺隐球菌病临床表现以咳嗽、咳痰最常见,胸部影像学以肿块或结节影最为常见,易误诊为肺癌或肺结核.经皮肺穿刺活检是确诊该病的主要手段,隐球菌荚膜多糖抗原检测敏感度较高,对临床诊治有较大帮助.肺隐球菌病以药物治疗为主,少数患者需手术.轻中症肺隐球菌病患者预后较好.
Objective To improve understanding of the clinical manifestations and imaging features of pulmonary cryptococcosis.Methods The clinical features,imaging characteristics,laboratory examinations,treatment and prognosis of 65 cases of pulmonary cryptococcosis were retrospectively analyzed.The data were collected from Nanjing General Hospital,Suqian Municipal People＇ s Hospital and People＇ s Liberation Army 81 Hospital from January 2001 to March 2013.Results There were 65 proven cases diagnosed with pulmonary cryptococcosis,including 44 males and 21 females,aged from 12 to 73 years [average （44 ± 13） years].The most common clinical symptoms included cough （n =32）,expectoration （n=20）,fever （n =16）,and chest pain （n =14）,while some patients（n =18） had no symptoms.Common chest imaging findings included single or multiple masses or nodules （n =36）,patchy infiltrates （n =19,and mixed lesions （n =10）.Among the 21 cases with cryptococcal capsular polysaccharide antigen detection,14 were positive.The antigen titre （≥ 1：8 for positivity）was positively correlated with disease severity and lesion extent.The diagnosis of 45 cases was proven by percutaneous lung biopsy and 3 were diagnosed by bronchoscopic biopsy,while 17 were confirmed by surgery.Among 65 patients,53 underwent Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） scoring,and 45 had a score of less than 10.Among them,38 cases acquired complete or partial recovery,4 were progressive and 3 died.Eight cases had a score of 10 or more,of whom 3 acquired complete or partial recovery,1 was progressive and 4 died.Conclusions The most common clinical manifestations of pulmonary cryptococcosis were cough and expectoration and the most common chest imaging features were masses or nodular shadows.Percutaneous lung biopsy was a commonly used method to diagnose this disease.Cryptococcal capsular polysaccharide antigen detection was helpful for the diagnosis and management with a relatively high sensitivity.Antifunga
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2014年第10期764-768,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
南京军区医药卫生科研基金面上项目（12MA082）
关键词
肺
隐球菌病
回顾性研究
Pulmonary
Cryptococcosis
Retrospective studies
