HIV阴性肺隐球菌病20例临床分析

Analysis of 20 Cases of Pulmonary Cryptococcosis in HIV-negative Patients

目的分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)阴性肺隐球菌病(pulmonary cryptococcosis,PC)患者的临床特点,提高临床医师对PC的认识。方法回顾分析2018年1月-2019年6月我院确诊的20例HIV阴性的PC病例资料。结果本组男性比例高,且好发于中年人,大部分患者症状较轻,CT表现以结节型及肿块型为主,大部分患者免疫功能正常,病灶多位于胸膜下,边界较清,增强扫描后呈轻中度强化,常合并有晕征、毛刺征。12例误诊为肺癌,5例误诊为普通肺炎,3例误诊为肺占位性病变,均经皮肺穿刺活检或手术病理确诊。确诊后经手术和(或)抗真菌治疗,病灶完全吸收或好转。结论HIV阴性PC患者易误诊为肺癌,掌握其影像学特点、及早行隐球菌抗原检测和经皮肺穿刺活检有助于早期诊治。

Objective To analyze the clinical characteristics of pulmonary cryptococcosis(PC)in HIV negative patients and to improve clinicians'understanding of PC.Methods A retrospective analysis was performed on 20 cases of human immunodeficiency virus(HIV)-negative PC diagnosed in our hospital from January 2018 to June 2019.Results The proportion of males in this group was high,and it often strikes middle-aged people.Most of the patients had mild symptoms,the CT manifestations were mainly nodules and masses,and most of the patients had normal immune function.Most of the lesions were located under the pleura with clear boundaries,and after enhanced scan,the lesions showed mild to moderate enhancement and frequently had halo sign and spicule sign.Among them,12 patients were misdiagnosed as lung cancer,5 patients were misdiagnosed as common pneumonia,and 3 cases were initially diagnosed as lung space-occupying lesions.All cases were diagnosed by percutaneous lung biopsy or surgical pathology.After diagnosis,the lesions were completely absorbed or improved by surgery and/or antifungal therapy.Conclusion PC in HIV-negative patients is more likely to be misdiagnosed as lung cancer,therefore,mastering its imaging features,early detection of cryptococcal antigen and percutaneous lung puncture are helpful for early diagnosis and treatment.