肺隐球菌病18例临床分析

Clinical analysis of 18 pulmonary cryptococcosis cases

目的探讨肺隐球菌病的临床特征,以提高对本病的认识。方法回顾性分析我院2001年1月-2008年8月经病理确诊为肺隐球菌病住院患者临床资料。结果本组肺隐球菌病以中青年男性为主,既往均无基础疾患。主要临床症状有咳嗽、咳痰、发热,病变影像学以肿块结节型为主,经CT引导下经皮肺穿刺活检证实7例,手术证实11例,病理诊断前误诊率达100%。11例经外科手术切除,其余应用抗真菌药物治疗,均取得较好疗效。结论肺隐球菌病多发生于中青年男性,临床表现无特异性,影像学改变以肿块结节型为主,误诊率高,确诊有赖于病理,对难以明确诊断者应尽早行病理检查。

Objective To study the clinical features of pulmonary cryptococcosis in order to improve our understanding of the disease. Methods Clinical data about 18 patients with pulmonary cryptococcosis pathologically diagnosed in our hospital from January 2001 to August 2008 were retrospectively analyzed. Results Most of the cases were males at the age of 30 and 50 years. None of them had underlying diseases. The main clinical manifestations were cough, expectoration and fever. Chest CT mainly showed multiple nodular masses. The diagnosis was confirmed by CT guided transthoracic lung biopsy and operation in 7 and 11 cases, respectively. The misdiagnosis rate was 100% before its pathologic diagnosis. Of the 18 patients, 11 underwent surgical resection and 7 received anti-fungal agents, which achieved rather good results. Conclusion Pulmonary cryptococcosis usually occurs in males at the age of 30-50 years with no specific clinical manifestations. Chest CT mainly shows pulmonary nodular masses. Its misdiagnosis rate is high and its final diagnosis depends on pathologic examination which should be considered as early as possible for those whose diagnosis is difficult to make.