肺隐球菌病的临床表现与患者基础免疫状态的关系

Pulmonary Cryptococcosis： Corre]ation Between Clinical Manifestations And Immune Status

肺隐球菌病主要发生于免疫抑制患者，有时也见于免疫正常者。临床症状缺乏特异性，以咳嗽最多见，其次为咳痰、发热、胸痛和呼吸困难。影像学表现多样，通常分为结节／团块影、片状浸润影和弥漫混合病变三种类型。免疫功能正常的患者临床症状轻，且相当一部分患者无症状，影像学表现多为结节影，感染部位局限，多不发生播散，预后好。HIV阴性免疫抑制患者往往多种症状同时存在，病情较重，影像学表现约三分之二的患者可见肺部结节内空洞，且弥漫混合病变增多，约50％的患者累及中枢神经系统。HIV感染患者罹患肺隐球菌病时病情重，常出现高热、呼吸困难、呼吸衰竭，多累及中枢神经系统，且往往为首发表现，预后差。

Pulmonary cryptococcosis （PC） typically occurs in immunocompromised patients, but it can also occur in im- munocompetent persons. Symptoms of PC are non-specific, cough is the most common symptom, followed by expectoration, fever, chest pain and dyspnea, and some patients may be asymptomatic. There are three types of radiologic abnormalities on chest com- puted tomography scans, including sotitary or multiple pulmonary nodules/masses, patchy infiltration, and diffusing mixed le- sions. The clinical manifestation of PC partly depends on immune status of patients.