肺隐球菌病75例回顾分析

Retrospective analysis of 75 patients pathologically diagnosed with pulmonary cryptococcosis

目的:分析肺隐球菌病(pulmonary cryptococcosis,PC)的临床特征、实验室检查、影像学特点、诊断及治疗。方法:回顾性分析2009年6月—2019年6月在南京医科大学第一附属医院经病理确诊的75例PC患者的临床资料。根据免疫状态分为免疫正常组(43例)和免疫受损组(32例)。结果:75例患者中,男50例,女25例,年龄(48.2±12.4)岁(17~80岁)。主要临床症状为咳嗽、咳痰、发热。27例患者无症状。两组淋巴细胞计数、纤维蛋白原、癌胚抗原、细胞角蛋白19片段、红细胞沉降率水平比较,差异有统计学意义(P<0.05)。PC影像学表现无特异性,结节肿块型33例、浸润实变型25例、混合型17例,两组在三者表现上比较,差异无统计学意义(P>0.05)。截至2019年9月30日,除4例失访外,59例患者行单独抗真菌药物治疗,12例患者行手术联合抗真菌药物治疗,治愈48例,好转18例,死亡5例。单独接受氟康唑治疗的有效率为96.4%(53/55)。结论:PC在免疫正常患者中并不罕见,其临床及影像学表现无特异性。诊断主要依赖病理学检查。常用的抗真菌药物对PC治疗效果较好,多数患者预后良好。

Objective:This study aims to investigate the clinical features,laboratory examinations,imaging characteristics,diagnosis and treatment of pulmonary cryptococcosis.Methods:The clinical data of 75 patients with pulmonary cryptococcosis,diagnosed from June 2009 to June 2019 in the First Affiliated Hospital of Nanjing Medical University,were retrospectively analyzed.According to the immune status,the enrolled patients were divided into an immunocompetent group with 43 cases and an immunocompromised group with 32 cases.Results:The patients consisted of 50 males and 25 females,with a mean age of(48.2±12.35)years(range,17 to 80 years).The main symptoms were cough,expectoration and fever.Twenty-seven patients were asymptomatic.There were differences in lymphocyte count,fibrinogen,carcinoembryonic antigen,cytokeratin 19 fragment and erythrocyte sedimentation rate in the two groups(P<0.05).Pulmonary cryptococcosis imaging showed no specificity,nodular or masslike shadows in 33,patchy infiltrates or consolidation in 25 and mixed lesions in 17 cases,there were no statistically significant differences between the two groups(P>0.05).Up to September 30,2019,except for 4 cases of lost follow-up,59 cases received antifungal drug therapy alone and 12 cases received surgery combined with antifungal drug therapy.Forty-eight cases were cured,18 cases were improved and 5 cases died.The effective rate of fluconazole alone was 53/55(96.4%).Conclusion:Pulmonary cryptococcosis is commonly seen in immunocompetent patients and it has no specific clinical and imaging manifestations.The diagnosis mainly relies on pathological examination.The commonly used of antifungal drugs have better effect on pulmonary cryptococcosis.Most patients with pulmonary cryptococcosis have a good prognosis.