免疫抑制和非免疫抑制患者肺隐球菌病临床特征分析

Clinical Features of Pulmonary Cryptococcosis in Immunocompromised and Immunocompetent Patients

目的探讨免疫抑制和非免疫抑制患者肺隐球菌病(PC)的临床特征,以期提高临床医师对本病的诊治水平。方法回顾性选取2008年1月—2015年12月于金华市人民医院住院的PC患者84例为研究对象。将患有AIDS、器官移植术后、长期使用糖皮质激素及免疫抑制药物的患者纳入免疫抑制组(43例),无以上疾病和未接受上述治疗的患者纳入非免疫抑制组(41例)。收集并比较两组患者一般资料、临床表现、辅助检查结果。结果免疫抑制组入院至确诊时间短于非免疫抑制组,住院时间长于非免疫抑制组,死亡率高于非免疫抑制组(P<0.05)。免疫抑制组头痛、恶心呕吐、合并隐球菌脑膜炎发生率高于非免疫抑制组(P<0.05)。免疫抑制组白细胞计数、血清清蛋白水平、血隐球菌荚膜多糖抗原阳性率、CD_3^+T淋巴细胞水平、CD_4^+T淋巴细胞水平低于非免疫抑制组(P<0.05);免疫抑制组单发结节/肿块型病灶发生率低于非免疫抑制组,多发结节/肿块型病灶发生率高于非免疫抑制组(P<0.05);免疫抑制组空洞征发生率高于非免疫抑制组,单侧肺受累发生率低于非免疫抑制组(P<0.05)。结论免疫抑制患者PC更易合并中枢神经系统隐球菌感染,多以头痛、恶心呕吐为首诊原因,病死率较高,隐球菌荚膜多糖抗原阳性率较低,以多发结节/肿块型病灶、双侧肺受累为主,空洞征发生率较高;而非免疫抑制患者PC以单发结节/肿块型病灶、单侧肺受累为主。

Objective To investigate the clinical features of pulmonary cryptococcosis（PC） in immunocompromised and immunocompetent patients with a view to helping clinicians to improve the level of diagnosis and treatment of the disease.Methods A retrospective study was conducted on 84 selected inpatients with PC treated in Jinhua People′s Hospital from January 2008 to December 2015.Of them,those with AIDS,or organ transplant,or long-term treatment with corticoid and immunosuppressive drugs were assigned to the immunocompromised group（43 cases）,and the other who had not the above mentioned diseases or treatment were assigned to the immunocompetent group（41 cases）.The baseline characteristics,clinical manifestations and auxiliary examination results were collected and compared between the two groups.Results Compared with the immunocompetent group,the immunocompromised group had shorter time needed to make the diagnosis（time was calculated from the admission）,longer length of stay and higher mortality rate（P〈0.05）.The incidences of headache,nausea and vomiting,and cryptococcal meningitis in the immunocompromised group were higher than those in the immunocompetent group（P〈0.05）.The white blood cell count,serum albumin level,the positive rate of cryptococcal capsular polysaccharide antigen,CD3＋T lymphocytes and CD4＋T lymphocytes levels in the immunocompromised group were lower than those in the immunocompetent group（P〈0.05）.The immunocompromised group had lower incidences of solitary nodule/mass lesion but higher incidences of multiple nodules/mass lesions than the immunocompetent group（P〈0.05）.The immunocompromised group had higher incidence of cavity and lower incidence of unilateral lung involvement compared with the immunocompetent group（P〈0.05）.Conclusion Immunocompromised patients with PC are prone to central nervous system involvement with headache,nausea and vomiting as the main reasons for most initial visits.Moreover,they are characterized by increased mortality rate,decreased positive rate of cryptococcal capsular polysaccharide antigen,and multiple nodules/mass lesions and increased probability of cavities and bilateral lung involvement as the main imaging performance.The immunocompetent patients with PC are often found to have a solitary nodule/mass lesion and unilateral lung involvement as the imaging performance.