HIV阴性患者肺隐球菌病的临床与CT影像分析

目的分析HIV阴性患者肺隐球菌病（PC）的临床与CT影像表现特点，以期提高肺隐球菌临床诊治水平方法回顾性分析1998年1月至2013年12月经病理证实的65例HIV阴性PC患者的临床资料结果65例PC患者中，33例患者有临床症状，主要表现为呼吸系统症状，出现胸痛9例32例患音无症状，包括2例外伤后检查发现一有基础疾病27例，有无基础疾病的两组PC患者影像学分型比较差异无统计学意义（P〉0．05）PC的伴随征象复杂，主要出现空气支气管征16例，空洞／空泡12例，分叶征11例，晕征4例，其中同一病灶内出现空气支气管征和小局灶坏死区10例有无基础疾病的两组PC患者影像学上出现主要征象的差异有统计学意义（P〈0．05）结论PC的临床症状不典型，中青年人群发病多见.CT影像表现复杂，常以结节和片状浸润影出现，病灶多为单肺叶分布，在肺下叶和外围带为主多芡混合型的多种形态病灶存在有一定特征性；单发结节型诊断困难PC伴随征象复杂，晕征对其诊断价值有限；同一病灶内空气支气管征和小局灶坏死区并存可能为PC一特殊征象，

Objective To analyze the clinical and CT imaging performance characteristics of HIV negative patients of Pulmonary Cryptococcosis. Methods We retrospectively reviewed the clinical date of 65 patients with HIV-negative PC who were diagnosed by pathology from January 1998 to December 2013 from Sir run run shaw hospital affiliated to Zhejiang university.Results A total of 65 patients with HIV-negative PC have been enrolled in the study. 33 patients with clinical symptoms, main show was respiratory symptoms, other 9 cases of chest pain, the rest symptoms no characteristic.32 cases of patients with asymptomatic at the time of diagnosis, including 2 cases was accidentally found after trauma.27 cases with underlying diseases, Presence of underlying conditions of two groups of patients with PC type image credits comparison difference has no statistical significance （ P〉0.05 ） .Images of PC showed diversity, Which can be divided into three types, including single nodule type and multiple mixed type and patchy consolidation type. With signs of PC were complex, air bronchogram appeared in 16 cases （ 24.62% ） , cavitas/vacuoles sign in 12 cases （ 18.46% ） , lobulation sign in 11 cases （ 16.92% ） , halo sign in 4 cases （ 6.15% ） , air bronchograms and focal necrosis area in 10 cases （ 15.38% ） which occured within the same lesion. Presence of underlying conditions of two groups of patients with PC, the main signs of the difference was statistical significance （ P〈0.05 ） .Diagnosis way of PC, to lesion biopsy by CT-guided （ 43 cases ） and surgical resection （ 21 cases ） , pathological diagnosis was given priority to. 58 cases （ 89.23% ） in pathological organization found focal granulomatous lesions. Conclusion Pulmonary cryptococcosis clinical symptoms were not typical, occasionally occurred in HIV-negative, young and middle-aged patients with asymptomatic. CT manifestation of PC was diversirorm, often appears in nodules and flake infiltrates shadows, Lesions often distribution of lung lower lobe and periphery, and often alone lung lobe be involvement.It has certain characteristic polymorphous lesions exists in multiple mixed type. single nodule type diagnosis difficult.Accompanying signs of PC were complex, halo sign of PC in the diagnosis of limited value, air bronchogram and focal necrosis area appeared in the same lesion may be a special sign of PC.