免疫健全和免疫抑制患者肺隐球菌病的CT表现

Clinical Findings and CT Characteristics of Pulmonary Cryptococcosis in Immunocompetent and Immunocompromised Patients

目的探讨不同免疫状态患者肺隐球菌病(pulmonary cryptococcosis,PC)的临床及CT表现,旨在提高对该病的认识和诊断水平。方法搜集经病理或细菌学证实的46例PC患者的临床及CT资料,分别对免疫健全和免疫抑制患者的CT征象进行分析。结果免疫健全患者临床症状较轻而CT表现较明显,CT像上以结节/肿块、实变影多见;免疫抑制患者临床症状与CT表现一致,CT像上以片状浸润/渗出影、空洞多见。结论 PC的CT表现多样化,病变多见于两下肺;其影像学表现与患者免疫状态有关,免疫健全患者以结节/肿块型为主。CT对PC的诊断有一定价值。

Objective To investigate clinical features and CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients, and to improve diagnosis. Methods 46 cases of pulmonary cryptococcosis （PC） proved by pathology or bacteriology were included. Clinical data and CT findings of different immune status were analysised respectively. Results Immunocompetent patients with PC showed mild clinical symptoms but obvious CT findings. The main CT manifestations included nodular/mass-like opacities and consolidation. Immunocompromised patients with severe clinical symptoms and obvious CT manifestations （patching infiltration shadows and cavity）. Conclusion CT characteristics of PC are diversiform and have relationship to different immune status. Lung lesions are commonly located in lower lobe. CT is valuable to the diagnosis of PC.