35例肺隐球菌病临床分析

Clinical analysis on 35 cases of pulmonary cryptoccosis

目的提高肺隐球菌病早期诊断与治疗的水平。方法对浙江大学医院附属第一医院2006年9月至2009年9月收治的35例病理确诊为肺隐球菌病患者的性别、年龄分布、职业情况、基础疾病、诱因、临床表现、实验室检查、影像学特征、治疗方案及预后特点等进行回顾性分析。结果患者以中青年男性为主,多数患者有基础疾病或诱因,临床症状相对轻微,其中40%无症状,一般实验室检查,气管镜检查及病原学检查阳性率极低,影像学表现以单发或多发结节肿块影为主(共占65.7%),氟康唑治疗3～9个月一般均能治愈,但亦有17.6%迁延不愈或无效者。结论中青年患者,无发热性肺部感染性病变,症状轻微,血象正常,血沉正常,痰细菌学检查阴性,考虑肺隐球菌病可能,尽早取得组织病理学依据,治疗首选氟康唑,疗程3～9个月,手术病理明确并病灶切除者,术后仍需常规应用氟康唑治疗。

Objective To improve early diagnosis and treatment effect of pulmonary cryptoccosis.Method A retrospective analysis was performed on 35 cases of patients with pulmonary cryptococcosis with regard to their demographic data,underlying diseases,causes,clinical symptoms and signs,laboratory data,imaging findings and prognoses.These patients were admitted in our hospital from September 2006 to September 2009.Result The majority of the patients were young and middle-aged men;most of them had underlying diseases or causes.There clinical manifestation,laboratory data,tracheoscopic and etiological results lacks specificity,40% of those were asymptomatic.The imaging findings showed that 65.7% of the patients had solitary or multiple tubercle which were cured with fluconazol in 3 ～ 9 monthes in general,yet 17.6% had seen no effect.Conclusion For those patients whose clinical manifestation and imaging findings lack specificity and might be misdiagnosed,we still can find some useful clues.Once a case is suspected to be pulmonary cryptoccosis,lung tissue biopsy or histopathology should be made early for diagnosis.Fluconazol is the first choice for treatment and the treatment period is 3 ～ 9 monthes in general.Patients who have accepted operation need the routine treatment of Fluconazol too.