53例非免疫缺陷肺隐球菌病的诊疗分析

Clinical diagnosis and analysis of 53 cases of non-immune deficiency pulmonary cryptococcosis

目的通过总结53例非免疫缺陷肺隐球菌病患者的临床特征,提高对非免疫缺陷肺隐球菌病的认识。方法回顾性分析2011年4月至2017年2月行CT引导下经皮肺穿刺活检或外科手术病理证实的肺隐球菌病患者的临床资料。结果共53例患者,其中男30例,女23例;年龄20-86岁,平均51岁;其中31例合并有基础病;所有患者均未行器官移植术,且HIV指标均为阴性。胸部CT扫描表现为实变渗出灶、结节状、团块状以及混合型。1例行胸腔镜手术切除治疗,经手术病理证实。52例经CT引导下经皮肺穿刺活检病理证实。53例患者中47例予以氟康唑、6例予以伊曲康唑治疗,疗程6-12个月,随访6个月-33个月。肺部病灶均有不同程度的吸收。结论非免疫缺陷肺隐球菌病的临床表现无特异性,胸部CT扫描多表现为多发或单发结节和肿块。49例乳胶凝集试验阳性,阳性率达92.4%。在随访中,治疗后的乳胶凝集定量试验滴度较治疗前明显下降。随访51例患者中,46例氟康唑治疗中,治愈30例,好转16例;而5例伊曲康唑治疗后均为好转。

Objective To improve the understanding of through summarizing of non-immune deficiency pul-monary cryptococcosis by summarizing the clinical features of 53 patients with non-immune deficiency pulmonary cryp-tococcosis. Methods The clinical data of non-immune deficiency pulmonary cryptococcosis from April 2011 to Feb-ruary 2017 were retrospectively analyzed. Results A total of 53 patients were selected, including 30 cases of male and 23 cases of female, aging from 20 to 86 with an average of 51 years old. 31 cases were complicated with basic diseases. All patients were not given organ transplantation, and the indexes of HIV were negative. Chest CT scans showed the consolidation were seepage oven, nodular, crumb and mixed. 1 case was given resection of thoracoscope surgery treatment, confirmed by surgery pathology. The rest 52 cases were pathologically confirmed with CT guided percutaneous lung biopsy. 47 of them were given fluconazole and 6 cases received itraconazole for 6-12 months. They were followed-up for 6 months to 33 months. Pulmonary lesions showed different degree of absorption. Conclu-sion The clinical manifestations of non immune pulmonary cryptococcosis are nonspecific, and chest CT scans usu-ally show multiple or solitary nodules and masses. Latex agglutination test is positive in 49 cases, and the positive rate is 92. 4%. During follow-up, the titer of latex agglutination test decreases significantly after treatment. For 46 cases treated with fluconazole, 30 cases are cured and 16 cases improved. All 5 patients treated with itraconazole are improved.