结节型与团块渗出型肺隐球菌病的临床特征分析

Clinical characteristics of nodular and massive exudative pulmonary cryptococcosis

目的:探讨结节为主型和团块渗出为主型肺隐球菌病(pulmonary cryptococcosis,PC)患者的临床特征,提高临床诊治水平。方法:回顾性选择2010年1月1日至2021年1月1日复旦大学附属中山医院非HIV感染PC的住院患者187例,依据首次诊断时胸部CT影像特征分为结节型组(n=121)和团块渗出型组(n=66),收集并分析2组年龄、性别、基础疾病、临床症状、炎症指标和隐球菌荚膜抗原(CrAg)等相关临床资料。结果:与结节型组相比,团块渗出型组患者发病年龄更早[(46.61±15.35)岁vs(53.31±12.39)岁,P<0.01],咳嗽(57.6%vs 35.5%,P<0.01)、咳痰(36.4%vs 17.4%,P<0.01)、发热(36.4%vs 11.6%,P<0.01)更多见,血沉[(28.34±24.11)mm/h vs(16.08±16.41)mm/h,P<0.01]、C-反应蛋白[(18.20±25.02)mg/L vs(6.35±12.71)mg/L,P<0.01]更高,淋巴细胞比例低于20%的发生率更高(46.9%vs 25.4%,P<0.01),CrAg阳性率更高(93.4%vs 81.3%,P<0.05),CrAg滴度更高[采用-lg值表示,(2.01±0.93)vs(1.08±0.81),(P<0.01)]。两组患者白细胞计数、中性粒细胞计数、中性粒细胞比例、淋巴细胞计数、降钙素原差异均无统计学意义。结论:非HIV感染PC患者胸部CT结节型更多见;与结节型患者相比,团块渗出型PC患者年龄更小、临床症状更多、炎症指标更高、CrAg阳性率及滴度更高。

Objective: To explore the differences of clinical manifestations of pulmonary cryptococcosis(PC) patients with pulmonary CT manifestations of nodules or masses exudation, and to improve early diagnosis and identification of PC.Methods: Totally, 187 non-HIV-infected inpatients diagnosed with PC from January 1, 2010 to January 1, 2020 at Zhongshan Hospital, Fudan University were enrolled. Based on chest imaging manifestations, patients were divided into two groups: nodular group(n=121) and mass exudative group(n=66). Relevant clinical data such as age, gender, underlying diseases, clinical symptoms, inflammation indicators, and cryptococcal capsular antigen(CrAg) were collected and analyzed of the 2 groups. Results: Compared with the nodular group, the age of onset in PC patients with mass exudation-based lesions was earlier([46.61±15.35] years old vs [53.31±12.39] years old, P<0.01);cough(57.6% vs 35.5%, P<0.01), sputum(36.4% vs 17.4%, P<0.01), and fever(36.4% vs 11.6%, P<0.01) were more common;the erythrocyte sedimentation rate(ESR)([28.34±24.11] mm/h vs [16.08±16.41]mm/h, P<0.01), C-reactive protein(CRP) level([18.20±25.02] mg/L vs [6.35±12.71] mg/L, P<0.01], the incidence of lymphocytes less than 20% was higher(46.9% vs 25.4%, P< 0.01), the positive rate of cryptococcal capsular antigen(CrAg)(93.4% vs 81.3%, P<0.05), and the average titer of CrAg(expressed as-lg value, [2.01±0.93] vs [1.08±0.81], P<0.01) were higher. There were no significant differences in white blood cell count, neutrophil count, lymphocyte count, and procalcitonin between the two groups.Conclusions: Nodular lesions are the most common CT findings in non-HIV-infected PC patients. PC patients with mass exudative lesions accompany with higher incidence rate of fever, cough, and sputum, higher level of ESR, CRP, as well as higher titer of CrAg.