非免疫缺陷肺隐球酵母菌病患者的临床分析

Clinical analysis of 20cases of non-immunodeficiency Cryptococcus neoformans pneumonia

目的研究非免疫缺陷肺隐球酵母菌病好转的临床特点,分析其临床特征和诊断方法,提高对肺隐球酵母菌病的认识和诊治水平。方法回顾性分析2009-2014年20例非免疫缺陷肺隐球酵母菌病患者的临床表现、影像学改变、实验室检查、病理表现、治疗与转归,研究数据采用SPSS13.0统计软件进行分析。结果 20例非免疫缺陷肺隐球酵母菌病患者中4例临床表现不明显,其主要临床表现以咳嗽及乏力为主,肺部CT表现为近胸膜团块实变影9例、病灶周围伴有晕征6例、空洞及纵隔淋巴结肿大各2例,分别占45.0%、30.0%、10.0%、10.0%,初诊时误诊12例,误诊率高达60.0%;经氟康唑或伏立康唑等抗真菌治疗后,患者肺部病灶明显吸收,随访未见其他脏器播散。结论非免疫缺陷肺隐球酵母菌病临床症状较轻,近胸膜团块实变影及病灶周围伴有晕征是其较常见的影像学表现,氟康唑是治疗的首选药物,治疗效果良好,愈后未见复发。

OBJECTIVE To study the clinical characteristics of patients with normal immune function and Crypto‐coccus neoformans pneumonia so as to raise awareness and improve diagnosis of curing it by analyzing the clinical features and diagnosis of non‐immune deficiency C .neoformans pneumonia .METHODS The clinical manifestation , imagelogical changes , laboratory inspection , pathological features , treatment and recovery of the 20 cases of patients with non‐immune deficiency C .neoformans pneumonia from 2009 to 2014 were retrospectively analyzed . All data were statistically analyzed by SPSS 13 .0 software .RESULTS A total of 4 cases in the 20 cases has unap‐parent clinical manifestation such as cough and fatigue ;lung CT showed 9 cases with mass consolidation shadows near to pleura ,6 cases with halo signs around the focus of infection ,2 cases with cavity and 2 cases with mediasti‐nal lymph nodes enlargement ,accounting for 45 % ,30 .0% ,10 .0% and 10 .0% ,respectively .There were 12 ca‐ses being misdiagnosed with the rate of up to 60% .By treating with antifungal therapy like fluconazole or voricon‐azole ,the patient＇s lung lesions were significantly absorbed .No dissemination to other organs was found in follow‐ups .CONCLUSION The clinical symptoms prove to be not severe in patients with non‐immune deficiency C .neo‐formans pneumonia .The common clinical manifestations are mass consolidation shadows near to pleura and the surrounding halo sighs .Fluconazole is the first drug choice with good therapeutic effect and less relapses .