非免疫缺陷原发性肺隐球菌病21例临床分析

Clinical analysis of non-immunodeficient pulmonary cryptococcosis

目的总结肺隐球菌病的临床资料,提高其诊疗水平。方法收集确诊的21例原发性肺隐球菌病患者的临床资料,对临床表现、实验室检查、影像学检查、病理学检查及治疗进行回顾。结果男性15例,女性6例。有基础疾病4例,无基础疾病17例。肺部症状不典型,有咳嗽、咳痰、发热、咯血、胸痛等;其影像学表现常见结节影、块影、片影等,可伴有空洞、毛刺等;孤立结节影6例,病灶累及双肺15例。初期误诊为肺癌行手术切除7例,误诊为结核4例,误诊为普通肺炎7例。17例抗真菌治疗有效,4例抗真菌治疗后行肺叶切除。结论肺隐球菌病临床及影像学表现不特异,无明显免疫缺陷者也可发病,常误诊为肺癌、肺结核、肺炎,确诊多依赖病理活检。多数患者抗真菌治疗有效,少数需手术治疗。

Objective To analysis and summarize the clinical data of pulmonary cryptococcosis （PC） in order to improve the level of its diagnosis and treatment. Methods 21 patients with primary pulmonary cryptocoecosis were collected, and their clinical manifestation, laboratory examination, imaging examination, pathological examination and treatment were retrospectively analyzed. Results 15 of them were male and 6 eases were female. There were 4 cases with basic diseases and 17 cases without basic diseases. Most of the symptoms were cough, expectora- tion, hemoptysis, chest pain and fever. Imaging performance such as nodular shadows, piece of shadow, shadow was common. Isolated nodular shadows existed in 6 cases, and lesions involving both lungs showed in 15 cases. There were 7 cases initially misdiagnosed as lung cancer, 4 cases misdiagnosed as tuberculosis, and 7 cases misdiagnosed as common pneumonia. 17 cases accepted antifungal therapy and 4 cases received lobectomy after antifungal therapy. Conclusion The clinical imaging findings of pulmonary cryptoeoceosis are not specific, and it is easily misdiagnosed as lung cancer, tuberculosis, and pneumonia. The confirmed diagnosis depends on pathological biopsy. The antifun- gal therapy is effective for most patients, but few of them need surgical treatment.