48例肺隐球菌感染的临床特征及预后

Clinical characteristics and prognosis of 48 patients with pulmonary cryptococcal infection

目的探讨肺隐球菌感染患者的流行病学状况、临床特征及疾病预后转归。方法选择2016年6月-2019年6月乐清市人民医院呼吸与危重症医学科收治的确诊为肺隐球菌感染的48例患者为研究对象,根据有无免疫缺陷分为免疫缺陷组37例和免疫正常组11例,对其流行病学状况、临床特征、治疗情况及疾病预后转归等资料进行回顾性分析。结果两组患者年龄、性别、发热病例数、发热温度、白细胞、中性粒细胞比例、尿素氮比较,均无统计学差异;免疫缺陷组C反应蛋白(CRP)、血沉高于免疫正常组,血白蛋白低于免疫正常组,比较差异有统计学意义(P<0.05);免疫缺陷组主要累及双侧肺,且多发,病灶主要累及在肺上叶和下叶;免疫功能正常组主要累及单侧肺,累及在胸膜下,且单发,其病灶主要累及在肺下叶,比较差异有统计学意义(P<0.05);两组结节肿块型、混合型患者之间的差异有统计学意义(P<0.05);免疫正常组治疗有效率为100.00%,免疫缺陷组治疗有效率为89.19%,免疫正常组治疗有效率高于免疫缺陷组,差异有统计学意义(P<0.05)。结论肺隐球菌感染的临床表现无特异性,其在免疫力缺陷和免疫力正常患者中均可发病,多发于免疫力缺陷患者,且免疫力缺陷的肺隐球菌患者预后较差。

OBJECTIVE To explore the epidemiological status, clinical characteristics and prognosis of the patients with pulmonary cryptococcal infection. METHODS A total of 48 patients who were diagnosed with pulmonary cryptococcal infection and treated in respiratory and critical care medicine department of Yueqing People’s Hospital from Jun 2016 to Jun 2019 were recruited as the study subjects and were divided into the immunodeficiency group and the normal immune group according to the immune status. The data such as epidemiological status, clinical characteristics, treatment status and prognostic outcomes were retrospectively analyzed. RESULTS There were no significant differences in the age, gender, number of cases of fever, body temperature, white blood cell level, percentage of neutrophils and urea nitrogen between the two groups. The C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) of the immunodeficiency group were significantly higher than those of the normal immune group, the blood albumin group of the immunodeficiency group was significantly lower than that of the normal immune group(P<0.05). Bilateral lungs were mainly involved and multiple in the immunodeficiency group, and the lesions mainly involved the upper and lower lobes of the lungs. Unilateral lung was mainly involved under the pleura and single, the lesions were mainly involved the lower lobe of the lung, and there were significant differences(P<0.05);there were significant differences in the types of modular mass and mixed types between the two groups(P<0.05). The effective rate of treatment of the normal immune group was 100.00%, significantly higher than 89.19% of the immunodeficiency group(P<0.05). CONCLUSION There are no specific clinical manifestations in the patients with pulmonary cryptococcal infection, both the immunodeficiency patients and the normal immune patients may have the infection, and the pulmonary cryptococcal infection is predisposed in the immunodeficiency patients, and the prognosis of the immunodeficiency patients with the infection is poor.