影像学疑似肺结核的隐球菌肺病31例诊断分析

Diagnostic analysis of 31 cases with pulmonary cryptococcosis looking like pulmonary tuberculosis in imaging

目的对影像学疑似肺结核(PTB)的隐球菌肺病(PC)病例进行诊断分析。方法收集1996～2008年疑似PTB的PC病例31例,并以同期收治的PTB32例作为对照,将两组的临床症状、实验室检查、影像学及病理学等资料进行回顾性对照研究。结果1.PC的体检发现者例数高于PTB,咳嗽、咳痰、发热、乏力症状少于PTB,P<0.05,而咯血、胸痛、盗汗、消瘦症状与PTB相差不大,P≥0.05。2.误诊为PTB的PC影像学表现以多发斑片、结节或斑片、结节、肿块影混合存在者居多;3.隐球菌乳胶凝集试验是诊断隐球菌感染的特异性较强的方法,也是PC与其它疾病相鉴别的有效方法。结论加强对PC的认识,可疑者尽早行乳胶凝集试验检测,同时寻找病原学及病理学确诊证据可提高PC的诊断水平。

Objective To analyze the diagnosis for cases with pulmonary cryptococcosis （PC） looking like pulmonary tuberculosis （PTB） in imaging. Methods The data of 31 cases with PC suspected to be PTB in imaging were collected during 1996 - 2008 in hospital, controlled by 32 cases with PTB during the same period. The clinical symptoms, lab tests, imaging and pathlogic results were analyzed. Results （ 1 ） PC had more cases with no symptoms than PTB. PC had less cough, sputum, fever, fatigue cases than PTB, （ P 〈 0. 05）. In term of hemoptysis, chest pain, night sweat, thin, PC had similar numbers of cases as that in FIB cases. （P≥0. 05）. 2. PTB had more patches, infiltrations or several imaging presentations of co - existing ; 3. PC latex agglutination test had important clinical and differential diagnostic value. Conclusion We should strength on the level of understanding PC. The suspected patients should be tested by PC latex agglutination as soon as possible. Meanwhile, finding of pathological and pathogenic evidence can help improve the diagnostic level of PC.