肺隐球菌病与肺曲霉菌病临床特点对比分析

Comparative analysis of clinical characteristics between pulmonary cryptococcososs and pulmonaryaspergillosis

目的探讨肺隐球菌病（pulmonarycryptococcosis，PC）和肺曲霉菌病（pulmonaryaspergillosis，PA）的临床特点的差异，为这两种疾病的临床鉴别提供依据，减少误诊或漏诊。方法回顾性分析2011年1月至2014年12月共4年期间广西医科大学第一附属医院经病理分别确诊为PC（29例）、PA（39例）患者的临床资料，从人口学特征、临床表现、影像学资料进行对比分析。结果PC组中18例存在宿主因素（3例）和（或）基础疾病（15例），基础疾病中肺外基础疾病占12例；27例出现临床症状，最常见咳嗽、咳痰；影像学表现结节团块型最多，获取组织病理最多的方法为手术肺活检（19例），其次为经皮肺穿刺活检9例。PA组中32例存在宿主因素（24例）和（或）基础疾病（32例），反复应用抗生素占18例，基础疾病中肺结核等肺部基础疾病占24例；33例出现临床症状，最常见咳嗽、咯血；影像学表现混合型最多，21例伴空洞形成，14例表现为空气新月征；获取病理方法手术肺活检最多。PC组中结节团块型、伴胸膜增厚、支气管充气征、病灶分布于左肺下叶、行经皮穿刺肺活检的病例数与PA组比较差异有统计学意义（P〈0．05）；而PA组在反复抗生素应用、合并肺结核基础疾病、咯血、伴钙化影、近邻支气管扩张、薄壁不规则空洞、空气新月征与PC组比较差异有统计学意义（P〈0．05）。结论PC和PA患者宿主免疫因素及基础疾病有所不同，两组问症状无特异性，PA出现咯血更常见，PC影像主要表现为结节团块型及支气管充气征，多伴胸膜增厚，而PA以混合型为主，空气新月征和曲霉球为PA的特征性表现。

Objective To explore the differences of clinical characteristics between pulmonary cryptococcosis （PC） and pulmonary aspergillosis （PA）, to provide the evidence for clinical identification of these two diseases and reduce misdiagnosis. Methods Retrospectively analyzing the clinical data of patients with respectively pathological confirmed of pulmonary cryptococcosis and pulmonary aspergillosis from Jan 2011 to Dec 2014 in the first affiliates hospital Of Guangxi medical university, dividing into PC group （29 cases） and PA （39 cases）, including demographic characteristics, clinical symptoms, imaging data. Results In the PC group, 18 cases complicated with host factors （3 cases） and （or） underlying diseases （15 cases）, non-pulmonary underlying disease cases accounted for 12 patients. 27 cases had clinical symptoms and the most was cough and sputum; The most common imaging was nodular/mass shadow type. The most common method to obtain histopathology was lung biopsy by operation （19 cases）, percutaneous lung biopsy was second （9 cases）, and in the PA group, 32 cases complicated withhost factors and （or） underlying diseases, 18 patients repeated use of antibiotics in host factor, and 24 patients had pulmonary diseases as tuberculosis. 33 cases had clinical symptoms and the most was cough and hemoptysis. The most common imaging was mixed type, 19 cases combined with cavities, and 14 cases combined with the air crescent sign. The most common method to obtain histopathology was also lung biopsy by operation. Patients in the PC group were significantly higher than in the PA group （ P 〈0.05） in terms of nodular/mass shadow type, pleural thickening, air bronchogram sign, distribution in the left lower lobe and through the percutaneous lung biopsy. But in the PA group in terms of repeated use of antibiotics, combined with pulmonary tuberculosis, haemoptysis symptom, with calcification shadow, neighbor bronchiectasis, irregular thin wailed cavity and air crescent sign were significantly higher than in the PC group （ P 〈0.05）. Conclusions PC and PA have some difference in terms of host immune factors and basic diseases respectively. There is no specificity in symptoms between two groups, but haemoptysis in PA is more common. The main imaging in PC is nodular/mass type, which is often combines with pleural thickening. The most common imaging is mixed type in patients with PA, and air crescent sign and pulmonay aspergillar glome is the imaging characteristic of PA.