免疫功能正常的肺隐球菌病17例临床分析

Clinical analysis of 17 cases of pulmonary cryptococcosis with normal immune function

目的分析免疫功能正常肺隐球菌病患者的临床特征,提高临床医生对该病的认识。方法回顾性分析郑州大学第一附属医院2011年1月至2017年12月经病理确诊的17例肺隐球菌病患者的临床资料。结果共17例患者,其中男14例,女3例,年龄27～75岁。职业分布为农民15例,工人1例,销售1例。3例有明确鸽粪及潮湿环境接触史。临床症状:6例(35.3%)无临床症状,11例(64.7%)患者因不同的临床症状就诊,其中咳嗽9例(52.9%),咳痰6例(35.3%),发热3例(17.6%),咯血1例(5.9%),胸痛3例(17.6%),胸闷2例(11.8%)。胸部CT特征:结节肿块病变11例(64.7%),浸润型病变2例(11.8%),混合型病变4例(23.5%)。病灶位于双肺5例(29.4%),左肺3例(17.6%),右肺9例(52.9%)。病灶多发12例(70.6%),单发5例(29.4%)。实验室检查:17例患者血沉、CRP、PCT、血常规均在正常范围内,17例患者均送痰培养,2例送血培养,均阴性。病理学表现:行碘酸-雪夫染色(PAS)及六胺银染色15例,13例(86.7%)阳性。治疗及预后:16例接受治疗。11例有临床症状的患者中应用氟康唑治疗10例,其中8例症状减轻,影像学显示病灶吸收,无变化1例,失访1例。1例给予两性霉素联合氟胞嘧啶治疗后症状减轻,影像学显示病灶吸收。5例体检发现肺部病变的患者采用氟康唑治疗后复查胸部CT显示病灶吸收。结论免疫功能正常的肺隐球菌病多以咳嗽主要表现,影像学表现以结节或肿块为主,病灶好发于右肺,肺穿刺活检阳性率高,合理规范治疗预后良好。

Objective To analyze the clinical features of patients with pulmonary cryptococcosis and improve the clinician’s understanding of the disease.Methods A retrospective analysis of clinical data of 17 patients with pulmonary cryptococcosis diagnosed by pathology from January 2011 to December 2017 in the First Affiliated Hospital of Zhengzhou University has been conducted.Results There were a total of 17 patients,including 14 males and 3 females,aged 27-75 years.There were 15 farmers,1 worker and 1 saler.3 cases had a history of pigeon manure and wet environment.Clinical symptoms:6 patients(35.3%)had no clinical symptoms,and 11 patients(64.7%)presented different clinical symptoms,including 9 cases(52.9%)of cough,6 cases(35.3%)of sputum,1 case(17.6%)of fever,1 case(5.9%)of hemoptysis,3 cases(17.6%)of chest pain,and 2 cases(11.8%)of chest tightness.CT features of the chest:11 cases(64.7%)were of nodular mass lesions,2 cases(11.8%)of invasive lesions,and 4 cases(23.5%)of mixed lesions.In 5 cases(29.4%),the lesions were located in the double lungs,3 cases(17.6%)in the left lung,and 9 cases(52.9%)in the right lung.Multiple lesions occurred in 12 cases(70.6%),and solitary lesions in 5 cases(29.4%).Laboratory examination:17 patients’erythrocyte sedimentation rate,CRP,PCT,and blood routine were all within the normal range,17 patients were given sputum culture,and 2 patients were given blood culture,all negative.Pathological findings:15 cases were performed PAS and hexamine silver staining,of which 13 cases(86.7%)were positive.Treatment and prognosis:There were 11 patients with clinical symptoms,10 were treated with fluconazole,of which 8 were relieved,the lesion was absorbed by imaging,1 was unchanged,and 1 was lost to follow-up.one cases were given amphotericin combined with fluorcytosine,and the symptoms were relieved.Five patients with lung lesions found during physical examination were reexamined with fluconazole for chest CT to show lesion absorption.Conclusion The main manifestation of pulmonary cryptococcosis with normal immune function is cough.The imaging manifestations are mainly nodules or masses.The lesions are predominant in the right lung,the positive rate of lung puncture biopsy is high,and the reasonable and standardized treatment has a good prognosis.