解放军总医院20年肺隐球菌病分析

Analysis of pulmonary cryptococcosis in Chinese PLA General Hospital in 20 years

目的 了解肺隐球菌病的宿主因素,描述其临床特征及诊疗,提高对肺隐球菌病的认识.方法 回顾性研究1993年1月1日-2013年9月30日本院符合确诊标准的肺隐球菌病病例.结果 入选肺隐球菌病39例,其中男性28例,女性11例.24例（61.5％）肺隐球菌病未发现合并基础疾病及发病的明确诱因,14例（35.9％）无症状和体征.常见临床症状为咳嗽19例（48.7％）,咳痰8例（20.5％）.26例（66.7％）CT表现为肺部结节.初诊确诊11例（28.2％）,初诊易误诊为肺结核、肺癌.发病距确诊时间5～172 d,平均确诊时间23.1 d,38例（97.4％）经病理确诊.本组患者无死亡,20例接受手术治疗,其中16例（80％）痊愈;10例接受药物治疗,其中7例（70％）好转（氟康唑治疗）,1例（10％）恶化.结论 肺隐球菌病在免疫正常人群亦可发病,肺隐球菌病临床症状及CT表现缺乏特异性,病理诊断是确诊依据,手术治疗可获得痊愈,氟康唑治疗有效率高,耐受性好.

Objective To study the host factors of pulmonary cryptococcosis,describe the clinical features,diagnosis and treatment,and improve the understanding of pulmonary cryptococcosis.Methods Clinical data of pulmonary cryptococcosis cases in Chinese PLA General Hospital from January 1993 to September 2013 were retrospectively analyzed.Results Of the 39 cases （28 males and 11 females） with pulmonary cryptococcosis,24 PC cases were not found any underlying diseases or inducements,14 cases （35.9%） were asymptomatic.19 cases （48.7%） were cough and 8 cases were sputum （20.5%）.26 cases （66.7%） performed as pulmonary nodules in CT chest scan.Initial diagnosis of PC which were easily misdiagnosed as tuberculosis or lung cancer were correct in 11 cases （28.2%） within 5-172 days （mean,23.1 days） since onset.38 cases （97.4%） out of the 39 patients were diagnosed by pathology.No patient died in this group.20 cases underwent surgery,and 16 patients （80%） recovered.Of the 10 patients received drug treatment,7 cases （70%） improved （with Cloconazole treatment）,1 case （10%） deteriorated.Conclusion Pulmonary cryptococcosis may attack the normal population with no specificity in clinical symptoms and CT findings.Pathological diagnosis are the basic diagnosis of PC,while surgical treatment can also cure PC.Cluconazole is the conventional medicine to treat PC with effectiveness and well tolerance.