77例肺隐球菌病临床病理特征分析

The clinical characteristics of pulmonary cryptococcosis in 77 patients

目的回顾性分析肺隐球菌病(pulmonary cryptococcosis,PC)患者的临床特征、免疫状态和治疗反应。方法研究2019年11月至2022年6月期间在我院经组织病理学诊断为PC的患者的病历、影像资料、实验室检查和治疗结果。结果共纳入77例患者,其中男性53例,女性24例。30例(38.96%)是免疫功能抑制患者。与免疫功能正常者(43.3±12.22)岁相比,免疫功能抑制患者发病年龄较高(54.5±12.95)岁。77人中有55人无症状(71.4%)。血清隐球菌荚膜抗原定性检测阳性率为68.0%。31.8%的患者有接触动物史,36.4%的患者在有粉尘的环境工作。多发实性结节是最常见的影像学类型(68.8%)。下肺是最常见的部位(85.7%),左右无差别。55例体检发现患者中,30.4%(7/23)的免疫功能抑制患者及28.1%(9/32)的免疫功能正常患者不接受治疗会出现影像学或症状加重。33例患者接受了抗真菌治疗,30例患者术后接受了抗真菌治疗,14例患者仅接受了手术切除。有3例患者在治疗后随访过程中出现新的结节。结论肺隐球菌病常见于免疫功能正常的患者,其年龄较免疫功能抑制患者年轻。多发实性结节是PC最常见的影像学表现,结合特殊的环境暴露和动物接触史以及血清隐球菌荚膜抗原检测可以提高诊断。

Objective To retrospectively analyze the clinical features,immune status,and therapeutic response of pulmonary cryptococcosis(PC)patients.Methods The medical records,imaging data,laboratory tests,and treatment results of patients diagnosed with PC by histopathology in our hospital between November 2019 and June 2022 were studied.Results A total of 77 patients were included,including 53 males and 24 females.30 cases(38.96%)were immunosuppressive.Compared with those with normal immune function(43.3±12.22)years old,the age of onset of immune suppression was higher(54.5±12.95)years old.Of 77,55 were asymptomatic(71.4%).The positive rate of serum cryptococcus capsular antigen was 68.0%.31.8%of the patients had a history of exposure to animals,and 36.4%worked in an environment with dust.Multiple solid nodules were the most common imaging type(68.8%).The lower lung was the most common site(85.7%),with no difference.Among the 55 patients,it was found that 30.4%(7/23)of the immunosuppressed patients and 28.1%(9/32)of the normal immunofunctional patients would have imaging or symptom aggravation without treatment.Thirty-three patients received antifungal therapy,30 patients received postoperative antifungal therapy,and 14 patients only received surgical resection.Three patients developed new nodules during follow-up after treatment.Conclusion Pulmonary cryptococcosis is more common in patients with normal immune function,and its age is younger than that of immunosuppressed patients.Multiple solid nodules are the most common imaging findings of PC.Combined with special environmental exposure and animal contact history,the detection of serum cryptococcus capsular antigen can improve the diagnosis.