肺隐球菌病113例临床分析

Clinical manifestations of pulmonary cryptococcosis:an analysis of 113 cases

目的对肺隐球菌病患者的临床表现及影像学特征进行分析总结,提高临床医生对该疾病的早期诊断识别。方法回顾性分析2014年1月至2019年3月于浙江大学医学院附属第二医院确诊为肺隐球菌病的113例患者的临床特征,并根据有无合并症、有无临床症状、隐球菌荚膜多糖抗原检测结果进行分组,分析不同组间患者基本情况、并发症、临床表现、实验室检查、影像学及血清抗原等临床特征的差异。结果113例患者中,男性患者多(74例,65.5%),年龄以40~60岁者最多(71例,62.8%)。影像学以结节-浸润斑片混合型为主(44例,38.9%),可伴有晕征(48例,42.5%)、支气管充气征(48例,42.5%)等。所有患者均使用氟康唑规范治疗,出院3个月后随访结果显示病情均有改善。有合并症患者较无合并症患者年龄大[(54.28±10.64)岁比(46.52±12.12)岁,t=-5.05,P<0.001],住院时间长[(10.42±6.11)d比(7.09±5.63)d,t=-4.28,P=0.007],白细胞水平低[(6.02±2.16)×10^(9)/L比(6.96±2.29)×10^(9)/L,t=2.44,P=0.027]。有症状患者与无症状患者比较,男性患者较少[56.2%(45/80)比87.9%(29/33),χ^(2)=19.54,P<0.001],影像学较多表现为浸润斑片影[32.5%(26/80)比9.1%(3/33),χ^(2)=18.25,P=0.031]。血清隐球菌荚膜多糖抗原阳性与抗原阴性患者的临床特征差异无统计学意义(均P>0.05)。结论肺隐球菌病患者以中年男性居多,影像学表现以结节-浸润斑片影混合多见;有无合并症对肺隐球菌病患者的住院时间有影响;无症状患者男性居多,浸润斑片影少见。

Objective To analysis of clinical and imaging characteristics of pulmonary cryptococcosis.Methods The clinical and imaging characteristics of 113 patients with pulmonary cryptococcosis who were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to March 2019,were retrospectively analyzed.Results Among 113 patients,74 cases(65.5%)were males,and 71 cases(62.8%)were at a age of 40-60 years.The imaging manifestations showed a nodular-infiltrating patchy mixed type(n=44,38.9%),accompanied by halo sign(n=48,42.5%)and bronchial air sign(n=48,42.5%).All patients were treated with fluconazole and the follow-up at 3 months after discharge showed their conditions were all improved.Subgroup analysis showed that patients with complications had older average age[(54.28±10.64)y vs.(46.52±12.12)y,t=-5.05,P<0.001],longer hospital stay[(10.42±6.11)d vs.(7.09±5.63)d,t=-4.28,P=0.007],lower white blood cell count[(6.02±2.16)×10^(9)/L vs.(6.96±2.29)×10^(9)/L,t=2.44,P=0.027].The symptomatic group had fewer male patients[56.2%(45/80)vs.87.9%(29/33),χ^(2)=19.54,P<0.001],and imaging was more likely to show infiltrative patchy[32.5%(26/80)vs.9.1%(3/33),χ^(2)=18.25,P=0.031].There was no significant difference in clinical and imaging manifestations between antigen positive group and antigen negative group(all P>0.05).Conclusions Most of the patients with pulmonary cryptococcosis are middle-aged men,and have nodular-infiltrating patchy mixed type in imaging;the complications would prolong the length of hospital stay.