HIV感染与非HIV感染患者肺隐球菌病的临床特点比较

Comparison of clinical characteristics of pulmonary cryptococcosis in patients with HIV infection and non-HIV infection

目的探讨HIV感染(human immunodeficiency virus infection,HIV)与非HIV感染患者合并肺隐球菌病的临床特点。方法收集中国科学技术大学附属第一医院2012~2019年40例确诊肺隐球菌病的住院患者,回顾性分析其临床资料,比较HIV感染与非HIV感染患者肺隐球菌病的临床特点。结果共收集40例肺隐球菌病患者,其中HIV感染组18例,非HIV感染组22例。HIV感染组平均年龄为(37.6±12.2)岁,非HIV感染组为(47.8±19.1)岁,差异有统计学意义(Z=-2.038,P=0.049)。HIV感染组的患者以发热为主,占55.6%;非HIV感染组的患者咳嗽占31.8%。HIV感染组双肺多发结节/肿块影占50.0%,比较多见;非HIV感染组患者肺单发结节/肿块影更多见,占36.4%。HIV感染组主要病理表现为黏液胶样型(72.2%),非HIV感染组为炎性肉芽肿型(68.2%)。HIV感染组18例经抗真菌治疗后均好转,非HIV感染组1例经手术切除及抗真菌治疗痊愈,2例因并发隐球菌性脑膜炎恶化,3例因出现隐球菌败血症死亡,其余16例均好转。结论两组肺隐球菌患者临床特点明显不同,在临床诊疗过程中应予以关注。

Objective To compare the clinical characteristics of pulmonary cryptococcosis between patients with and without human immunodeficiency virus infection.Methods he clinical data of 40 patients with pulmonary cryptococcosis diagnosed in the First Affiliated Hospital of China University of science and technology from 2012 to 2019 were retrospectively analyzed,and the clinical characteristics of pulmonary cryptococcosis between HIV infected and non HIV infected patients were compared.Results A total of 40 patients with pulmonary cryptococcosis were enrolled,18 in the HIV group and 22 in the non-HIV group. The mean age of the patients in the HIVgroup was(37.6±12.2) years old,and the mean age of the non-HIV group was(47.8±19.1) years. The difference was statistically significant(P=0.049). Patients in the HIV group had fever mainly,accounting for 55.6%,and patients in the non-HIV group coughed 31.8%. Multiple nodules/mass shadows in both lungs in the HIV group accounted for 50.0%,which were more common,and single nodules/mass shadows in the lungs in the non-HIV group were more common,accounting for 36.4%. The main pathological manifestations of the HIV infection group were mucus glue(72.2%),and the non-HIV infection group was inflammatory granuloma(68.2%). In HIV infection group,18 cases were improved after antifungal treatment,1 case in non HIV infection group was cured by surgical resection and antifungal therapy,2 cases were deteriorated due to cryptococcal meningitis,3 cases died of cryptococcal septicemia,and the remaining 16 cases were improved.Conclusion The clinical characteristics of two groups of pulmonary cryptococci patients were significantly different,which should be paid attention to in the process of clinical diagnosis and treatment.