肺隐球菌病117例回顾分析

Retrospective analysis of 117 cases of pulmonary cryptococcosis

目的 探讨肺隐球菌病（PC）的临床及影像学特点.方法 回顾分析福建省福州肺科医院2009年1月至2013年12月经病理确诊的117例PC患者的临床资料.结果 117例中,男75例,女42例,年龄16 ～76岁,平均（44±14）岁.免疫功能受损宿主（ICH）和非免疫功能受损宿主（NICH）分别为38例和79例.临床症状较轻,主要为咳嗽和咯痰.胸部CT特征：（1）表现为结节肿块病变66例,浸润实变病变34例,混合性病变17例;（2）以晕征和近端支气管充气征最多见.NICH组上述两种征象的发生率高于ICH组,二者比较差异有统计学意义（77.2％,44.7％,P=0.001;60.8％,39.5％,P=0.047）.浸润性病变和混合性病变出现上述征象的比例均高于结节肿块性病变,三者比较差异有统计学意义（82.4％、82.4％和54.5％,P=0.007;76.5％、82.4％和33.3％,P =0.000）;后者出现分叶、毛刺及胸膜凹陷征的比例高于前两者,三者比较差异有统计学意义（0％、5.9％和30.3％,P=0.000;0％、5.9％和27.3％,P=0.000;0％、5.9％和19.7％,P=0.005）.（3）病灶位于肺野外带106例,以右肺、下叶多见.NICH组比ICH组的病变更易累及多叶.38例行CT增强检查,24例均匀强化,27例中度强化.所有患者均经病理确诊.除16例失访外,其余101例患者均在本院接受治疗,71例治愈,30例好转.结论 PC临床症状缺乏特异性,影像学表现的晕征和近端支气管充气征对诊断有一定帮助,多数患者预后良好.

Objective To investigate the clinical features of pulmonary cryptococcosis （PC）.Methods A total of 117 cases of PC,confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2009 to December 2013,were studied.Results The patients consisted of 75 males and 42 females,with a mean age of （44.1 ± 13.7） years （range,16 to 76 years）.Thirty-eight cases were immunocompromised hosts （ICH） and 79 cases were non-immunocompromised hosts （NICH）.The clinical symptoms of most patients were mild and the main clinical manifestations were cough and sputum production.The chest CT manifestations were as follows：nodular or mass-like shadows in 66,patchy infiltrates or consolidation in 34,and mixed lesions in 17 cases.There were a variety of CT signs accompanied,with halo sign （78 cases） and proximal air bronchogram （63 cases） being the most common.These two signs were more common in NICH than ICH （77.2%,44.7%,P =0.001;60.8%,39.5%,P =0.047）.They were also more likely to be seen in the patchy infiltrates or consolidation and mixed patterns than in nodular or mass-like type of PC （82.4%,82.4% and 54.5%,P =0.007;76.5 %,82.4% and 33.3%,P =0.000）,while lobulation sign,spicule sign and pleural indentation were more likely to be seen in the latter（0%,5.9% and30.3%,P=0.000;0%,5.9% and 27.3%,P=0.000;0%,5.9% and 19.7%,P=0.005）.The lesions of PC were mainly found in the right lung and lower lobes.The lesions in NICH were more commonly seen in multiple lobes than ICH.Enhanced CT scanning was performed in 38 patients,and 24 cases showed uniform enhancement and 27 moderate enhancement.The diagnosis was confirmed in all cases by pathological findings.A hundred and one cases were treated and carefully followed in our hospital except 16 cases who were lost for follow-up.Seventy-one were cured and 30 were improved.Conclusions The clinical symptoms of PC were diverse and nonspecific.Halo sign and proximal air bronchogram are helpful for the diagnosis of PC.The outcome of most patients was satisfactory after appropriate treatment.