不同免疫状态患者肺真菌病菌种分布及临床特征

Pathogenic Spectrum and Clinical Features of Pulmonary Fungal Disease in Patients with Different Immune Status

目的探讨不同免疫状态患者肺真菌病的菌种分布及临床特征的差异,为提高临床早期诊治水平提供理论依据。方法选择2018年1月至2021年10月郑州大学第一附属医院收治的确诊为肺真菌病的256例患者为研究对象,根据免疫状态分为免疫抑制组(n=129)和非免疫抑制组(n=127)。回顾性分析菌种分布及临床特征。结果经病理确诊,肺曲霉病155例(60.55%),肺隐球菌病67例(26.17%),肺毛霉病29例(11.33%),肺孢子菌病3例(1.17%),肺念珠菌病1例(0.39%),肺放线菌病1例(0.39%)。免疫抑制组年龄、C-反应蛋白、降钙素原、基础疾病、发热病例数、肺毛霉病的发生率高于非免疫抑制组,血白蛋白、肺隐球菌病的发生率低于非免疫抑制组,差异有统计学意义(P<0.05);免疫抑制组患者病灶分布以多肺叶多见,非免疫抑制患者单肺叶多见,差异有统计学意义(P<0.05);两组CT征象比较,非免疫抑制组“空气新月征”“曲霉球”的发生率较高,差异有统计学意义(P<0.05)。结论病理确诊的肺真菌病中,肺曲霉病最常见,其他依次为肺隐球菌病、肺毛霉病、肺孢子菌病、肺念珠菌病及肺放线菌病。肺毛霉病多发生在免疫抑制患者中,肺隐球菌病多发生于非免疫抑制患者中。免疫抑制肺真菌病多表现为多肺叶的结节肿块影,应及时行肺活检明确诊断。

Objective To explore the pathogenic spectrum and clinical features of pulmonary fungal disease in terms of immune status of patients,so as to provide theoretical basis for improving the level of clinical early diagnosis and treatment.Methods A total of 256 patients diagnosed with pulmonary fungal disease admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to October 2021 were selected as the research subjects and were divided into the immunocompromised group and the immunocompetent group according to the immune status.The pathogenic spectrum and clinical features were retrospectively analyzed.Results There were 155 cases(60.55%)of pulmonary aspergillosis,67 cases(26.17%)of pulmonary cryptococcosis,29 cases(11.33%)of pulmonary mucormycosis,3 cases(1.17%)of penumocystisis,1 case(0.39%)of pulmonary candidiasis,and 1 case(0.39%)of pulmonary actinomycosis.The age,C-reactive protein,procalcitonin,basic diseases,fever cases and pulmonary mucormycosis of the immunocompromised group were higher than those of the immunocompetent group,the blood albumin and pulmonary cryptococcosis of the immunocompromised group were lower than those of the immunocompetent group(P<0.05).The distribution of lesions in the immunocompromised group was more common in multiple lung lobes,while the single lung lobes were more common in the immunocompetent group(P<0.05).Comparing the CT signs of the two groups,the incidence of“air crescent sign”and“aspergilloma”in the immunocompetent group were higher(P<0.05).Conclusion Among patients with pathological diagnosis of pulmonary fungal disease,pulmonary aspergillosis was the most common,followed by pulmonary cryptococcosis,pulmonary mucormycosis,pneumocystis,pulmonary candidiasis and pulmonary actinomycosis.Pulmonary mucormycosis occurs more frequently in immunocompromised patients and pulmonary cryptococcosis is more common in immunocompetent patients.Immunocompromised pulmonary fungal disease usually presents as multilobe nodules,which should be diagnosed by lung biopsy in time.