16例肺隐球菌病临床特征分析

Analysis of Clinical Features of 16 Cases of Pulmonary Cryptococcosis

目的通过对免疫功能正常的肺隐球菌病(PC)患者的临床特征分析,从而提高对该病的认识和诊治水平。方法方便选取2012年12月—2017年6月该院收治的肺隐球菌病患者16例,对这16例患者的临床资料进行分析。结果该研究发现,咳嗽7例(占43.75%)、咳痰5例(占31.25%)是肺隐球菌病最常见的临床表现,然后依次是发热、胸痛、呼吸困难等,其中无任何临床症状患者4例(占25.00%);肺隐球菌病的影像学多种多样,其中肺结节/肿块型9例(占56.25%),其次分别为肺实质浸润型5例(占31.25%),弥漫性2例(占12.50%),病灶累及单侧肺11例(占68.75%),分布于下肺14例(占87.50%)等。15例患者经氟康唑治疗后治愈或好转,1例患者外科手术切除后治愈。结论肺隐球菌病临床表现和影像学表现缺乏,容易误诊为肺癌或肺结核等疾病。遇到疑似病例应行血清乳胶凝集试验及肺活检或手术病理予以明确。氟康唑对该病治疗有效。

Objective To improve the understanding and diagnosis of the disease by analyzing the clinical features of patients with normal immune function of pulmonary cryptococcosis（PC）. Methods 16 patients with pulmonary cryptococcosis admitted to the hospital from December 2012 to June 2017 were convenient selected and enrolled. The clinical data of these 16 patients were analyzed. Results The study found that 7 cases of cough（accounting for 43.75%） and5 cases of cough（31.25%） were the most common clinical manifestations of pulmonary cryptococcosis, followed by fever,chest pain, dyspnea, etc., without any clinical symptoms. There were 4 patients（25.00%）; the imaging of pulmonary cryptococcosis was diverse, including 9 cases of pulmonary nodules/lumps（56.25%）, followed by 5 cases of pulmonary parenchymal infiltration（31.25%）. There were 2 cases（12.50%） diffuse, 11 cases（68.75%） with unilateral lung and 14 cases（87.50%） in the lower lung. 15 patients were cured or improved after fluconazole treatment, and 1 patient was cured after surgical resection. Conclusion The clinical manifestations and imaging findings of pulmonary cryptococcosis are lacking and are easily misdiagnosed as diseases such as lung cancer or tuberculosis. In case of suspected cases, serum latex agglutination test and lung biopsy or surgical pathology should be made clear. Fluconazole is effective in treating this disease.