血清隐球菌荚膜多糖抗原检测和呼吸介入方法在肺隐球菌病中的诊断价值

Diagnostic value of serum cryptococcal capsular polysaccharide antigen detection and interventional procedures in pulmonary cryptococcosis

目的评价血清隐球菌荚膜多糖抗原(CrAg)检测、超声引导下经支气管镜肺活检(EBUS-TBLB)和CT引导下经皮穿刺肺活检在肺隐球菌病(pulmonary cryptococcosis,PC)中的诊断价值,并分析其影响因素。方法回顾性分析2015年1月至2020年12月在东南大学附属中大医院病理确诊为PC的41例患者临床资料,均行血清CrAg检测。结果41例患者中,行EBUS-TBLB 32例,确诊16例,敏感性50%(16/32),行CT引导下经皮穿刺肺活检23例,确诊22例,敏感性95.7%(22/23),3例经外科手术确诊;41例患者中血清CrAg检测阳性29例,敏感性70.7%(29/41),联合EBUS-TBLB后敏感性可提高至96.9%(31/32)。影像学特征对EBUS-TBLB诊断PC敏感性无明显影响;肺部病变范围越广和机体有免疫抑制状态时,血清CrAg检测诊断PC敏感性越高。结论CT引导下经皮穿刺肺活检在诊断PC方面更有优势;联合使用EBUS-TBLB和血清CrAg检测可以明显提高其诊断PC的敏感性;对于肺部病变范围广和免疫抑制的患者,血清CrAg检测在诊断PC方面具有很好的敏感性。

Objective To evaluate the diagnostic value of pulmonary cryptococcosis(PC)for serum cryptococcal capsule polysaccharide antigen(CrAg)detection,ultrasound-guided transbronchial lung biopsy(EBUS-TBLB)and CT-guided percutaneous lung biopsy,and to analyze the affecting factors.Methods From January 2015 to December 2020,41 patients diagnosed pathologically with PC in Southeast University Zhongda Hospital were analyzed retrospectively;serum CrAg detection was performed in all patients.Results Among the 41 patients,32 patients underwent EBUS-TBLB and 16 were confirmed PC,the sensitivity was 50%(16/32),23 patients underwent CT-guided percutaneous lung biopsy and 22 were diagnosed,with the sensitivity 95.7%(22/23),while 3 were comfirmed by surgery;29 cases were positive for CrAg detection in the 41patients(sensitivity of 70.7%),while the sensitivity could be increased to 96.9%combined with EBUS-TBLB;Imaging features had no significant effect in the diagnosis of PC for EBUS-TBLB.Patients had wider lesions of the lung and had immune suppression,whose sensitivity of serum CrAg detection in PC was higher.Conclusions CT guided percutaneous lung biopsy has more advantages in the diagnosis of PC;combined with EBUS-TBLB and serum CrAg detection can significantly improve the sensitivity,and serum CrAg detection has a good sensitivity when the range of lung lesions were wide and patients were in immunosuppression.