免疫菌正常人群原发性肺隐球病12例临床分析

Clinical analysis of 12 immunocompetent patients with primary pulmonary cryptococcosis

目的探讨免疫正常人群原发性肺隐球菌病的临床特点、胸部影像学表现,提高对原发性肺隐球菌病的诊治水平。方法回顾性分析2008-072015-07我院经手术或经皮肺活检病理明确诊断肺隐球菌病12例患者的临床、影像学和病理资料,分析其特点。结果 12例患者中男8例,女4例,平均年龄（42.4±7.6）岁,既往健康。6例患者表现为轻度咳嗽、咳痰,2例低热、胸痛。6例胸部CT表现孤立团块、结节影或多发结节影。5例为多发性实变影,可见支气管充气征,反晕征。弥漫性片状浸润影1例。3例孤立性团块、结节病灶手术切除,氟康唑治疗4月,无复发。9例患者氟康唑治疗6-12月,病变明显吸收。结论免疫正常人群原发性肺隐球菌病患者症状轻微,胸部影像学无特异性。经皮肺活检病理是确诊的重要手段。手术可以治愈,氟康唑治疗效果良好。

Objective To improve the diagnosis and treatment of primary pulmonary cryptococcosis by retrospective analysis of clinical characteristics and chest radiography of immunocompetent patients with pulmonary cryptococcosis. Methods Clinical,radiogological and pathological data of 12 immunocompetent patients with pulmonary cryptococcosis confirmed by surgical or percutaneous lung biopsy were retrospectively analyzed. Results The 12 patients（ 8 males and 4 females,mean 42. 2 ± 7. 6 years old） were previously healthy. Six cases of them presented mild cough and expectoration,and two cases presented low-grade fever and chest pain. Six cases showed solitary mass and nodule or multiple nodules in chest CT scan. Five cases showed multiple consolidation shadow with air bronchograms and reversed halo sign. One case showed diffuse patchy shadow. Three cases of solitary mass and nodule underwent surgery,and then received fluconazole treatment and recovered. Nine cases received fluconazole treatment and pulmonary lesions were significantly reduced. Conclusion Patients with immunocompetent primary pulmonary cryptococcosis have only mild clinical symptoms and chest radiological imaging shows no specificity. Histopathological diagnosis of percutaneous lung biopsy is a mainly confirmed method. The surgical treatment can cure primary pulmonary cryptococcosis,and fluconazole also acquire effectiveness.