20例HIV阴性患者肺隐球菌病的临床分析

Clinical analysis of 20 patients with pulmonary cryptococcosis and without human immunodeficiency virus infection

目的分析肺隐球菌病患者的临床特征和检查结果,提高临床对隐球菌病的认识及诊疗水平。方法回顾性分析2013年1月至2018年6月在同济医院住院的20例HIV阴性肺隐球病确诊患者的临床资料、检查结果及隐球菌培养的药敏结果,分析肺隐球菌病的临床和检查结果特点。结果20例患者中,男性12例,女性8例,年龄23-70岁,平均为49.5±12.38岁,其中13例存在基础病,7例无明显基础疾病。常见症状为咳嗽、咳痰、发热、呼吸音异常、胸闷、咯血。胸部CT检查结果为肿块、结节者9例(45%),弥漫混合病变者7例(35%)、片状浸润影者4例(20%)。血常规、血沉结果无明显异常,超敏CRP均值为25.7±24.4mg/L,血清隐球菌荚膜抗原检测的阳性率为94.4%。14株培养阳性的新型隐球菌对两性霉素B、5氟胞嘧啶和氟康唑的敏感率均为100%。18例患者经4-6个月抗真菌治疗后临床症状及影像学表现均有不同程度好转,失访2例。结论肺隐球菌病临床表现无特异性;血清隐球菌荚膜抗原的检测对肺隐球菌病的诊断价值较高;常用抗真菌药物对肺隐球菌病的治疗效果较好。

Objective To analyze the clinical characteristics and examination results of patients with pulmonary cryptococcosis,so as to improve the clinical understanding of cryptococcosis and the level of diagnosis and treatment.Methods The clinical data,examination results and drug susceptibility of Cryptococcus culture of 20 patients with HIV-negative pulmonary cryptococcosis diagnosed in Tongji Hospital from January 2013 to June 2018 were retrospectively analyzed,and the characteristics of clinical and examination results of pulmonary cryptococcosis were analyzed.Results Among the 20 patients,there were 12 males and 8 females,aged from 23 to 70 years,with an average age of49.5±12.38 years.Among them,13 had basic diseases and 7 had no obvious basic diseases.The common symptoms were cough,expectoration,fever,abnormal breathing sound,chest tightness and hemoptysis.Chest CT findings were masses and nodules in 9 cases(45%),diffuse mixed lesions in 7 cases(35%)and patchy infiltration in 4 cases(20%).The results of routine blood test and ESR were not abnormal.The mean value of hs-CRP was 25.7±24.4 mg/L.The positive rate of cryptococcal capsular antigen in serum was 94.4%.The susceptibility rates of 14 Cryptococcus neoformans to amphotericin B,5-fluorocytosine and fluconazole were 100%.The clinical symptoms and imaging manifestations of 18 patients improved in varying degrees after antifungal treatment four to six months,and two patients were lost to follow-up.Conclusion The clinical manifestations of pulmonary cryptococcosis are not specific.The detection of cryptococcal capsular antigen in serum is of high diagnostic value for pulmonary cryptococcosis.The therapeutic effect using commonly antifungal drugs on pulmonary cryptococcosis is better.