肺隐球菌病34例临床分析

Clinical analysis of 34 cases of pulmonary cryptococcosis

目的:探讨肺隐球菌病的临床特点、CT影像学表现及诊治情况。方法:2016年1月-2020年1月收治肺隐球菌病患者34例,对临床资料及治疗效果进行回顾性分析。结果:34例患者中,存在基础疾病的免疫损害8例,免疫功能正常26例;有26例患者因症状就诊,最常见临床表现为咳嗽、咳痰、发热、胸闷、咯血、胸痛;肺部CT影像改变包括多发结节、单发结节、肺炎实变等;经病理确诊10例,血隐球菌荚膜多糖抗原阳性31例。所有患者均单纯使用抗真菌药物治疗,除6例失访外,其余28例中,治愈14例,好转14例。结论:肺隐球菌病患者临床表现及影像学特点缺乏特异性,易误诊为肺结核及肺癌;隐球菌荚膜多糖抗原检测有助于早期诊断;明确诊断依赖于组织病理学检查。

Objective:To discuss the clinical features,CT imaging findings,diagnosis and treatment of pulmonary cryptococcosis.Methods:From January 2016 to January 2020,34 patients with pulmonary cryptococcosis were enrolled,their clinical data and therapeutic effect were analyzed retrospectively.Results:Of the 34 patients,there were eight cases of immune damage from underlying diseases,26 cases had normal immune function.There were 26 patients who were treated due to symptoms,the most common clinical manifestations were cough,expectoration,fever,chest tightness,hemoptysis and chest pain.CT imaging changes of pulmonary included multiple nodules,single nodules,pneumonia consolidation and so on.10 confirmed cases were diagnosed by pathology,31 confirmed cases were diagnosed by positive antigen of cryptococcus capsular polysaccharide antigen.All patients were treated with antifungal drugs alone,except for 6 cases were lost to follow-up,among the remaining 28 cases,14 cases were cured and 14 cases were improved.Conclusion:The clinical manifestations and imaging features of patients with pulmonary cryptococcosis are lack of specificity and they are easily misdiagnosed as pulmonary tuberculosis and lung cancer.Detection of cryptococcus capsular polysaccharide antigen is helpful for early diagnosis,so definite diagnosis depends on histopathological examination.