结核病与肺部健康杂志 ›› 2013, Vol. 2 ›› Issue (3): 175-180.doi: 10.3969/j.issn.2095-3755.2013.03.009

• 论著 • 上一篇    下一篇

56例原发性肺隐球菌病的临床分析

黄进宝,翁恒,李红艳,兰长青,王洁,林清华,陈丽珠   

  1. 350008 福建省福州肺科医院呼吸内科(黄进宝、翁恒、李红艳),影像科(兰长青、王洁),病理科(林清华、陈丽珠)
  • 收稿日期:2012-11-24 出版日期:2013-09-30 发布日期:2013-09-30
  • 通信作者: 李红艳,Email:1353626039@qq.com

Analysis of 56 cases of primary pulmonary cryptococcosis

HUANG Jin-bao,LI Hong-yan,WENG Heng, LAN Chang-qing,WANG Jie,LIN Qing-hua,CHENG Li-zhu   

  1. Department of Respirology,Fuzhou Pulmonary Hospital of Fu Jian,Fuzhou 350008,China
  • Received:2012-11-24 Online:2013-09-30 Published:2013-09-30
  • Contact: LI Hong-yan,Email: 1353626039@qq.com

摘要: 目的探讨肺隐球菌病的临床症状、影像学表现、实验室检查、诊断、鉴别诊断、治疗方法及预后,以提高对本病的认识。方法搜集福建省福州肺科医院自2007年1月至2012年2月曾收治并经病理确诊的共56例原发性肺隐球菌病的临床资料,并对有关资料进行回顾性分析。结果肺隐球菌病以中青年(32例,57.14%)和男性(37例,66.07%)多见,年龄16~76岁,平均(44±13)岁。伴有基础疾病者20例(35.71%),但人类免疫缺陷病毒抗体(HIV-Ab)均阴性。临床症状较轻,主要为咳嗽(42例,75.00%)、咯痰(39例,69.64%)。胸部CT表现:51例(91.07%)病变位于胸膜下,病灶仅限于下肺者24例(42.86%);以单发或多发的结节、肿块影多见,共34例(60.71%);斑片和(或)片状实变影12例(21.43%);斑点、斑片、条索、结节或团块影等多种形态混杂存在者8例(14.29%),孤立空洞影2例(3.57%)。伴支气管充气征22例(39.29%),晕征12例(21.43%)。13例行肺部增强CT检查,其中病灶均匀强化10例(76.92%),不均匀强化3例(23.08%)。19例(33.93%)经电视辅助胸腔镜手术病理确诊,18例(32.14%)经CT引导下经皮肺穿刺活检病理确诊,19例(33.93%)经纤维支气管镜肺活检病理确诊。52例患者在本院接受药物或手术治疗,其中治愈39例(75.00%),好转13例(25.00%)。结论原发性肺隐球菌病的临床表现缺乏特异性,但影像学表现仍具有一定特征性,确诊主要依赖肺活检组织病理学检查。若诊断及时,治疗合理,大多数患者预后良好。

Abstract: Objective To investigate the clinical symptoms,radiology,laboratory data,diagnosis,different diagnosis,management and prognosis of pulmonary cryptococcosis.Methods A total of 56 cases of primary pulmonary cryptococcosis,confirmed by pathological examinations at Fuzhou Pulmonary Hospital of Fujian from January 2007 to February 2012,were studied.Results Thirty-two of 56 cases(57.14%) were under 50 years old and 37(66.07%) were male patients.Aged from 16 to 76 years. There were no underlying diseases in 36 cases. The main clinical manlfestations were cough(42 cases,75.00%) and cough up phlegm (39 cases,69.64%).Chest CT study showed that the majority of the lesions (51 cases) were close to the pleura. Lower lungs were often involved (24 cases). Pulmonary nodules and mass (34 cases,60.71%),either solitary nodules or multiple nodules,were the most common CT finding. Air bronchogram(22 cases,39.29%) and halo sign(12 cases,21.43%) were the common accompanying signs. Enhanced CT scanning was made in 13 patients and 10 cases(76.92%) showed uniform enhancement. The diagnosis was confirmed in all cases by pathological findings. Succeessful outcomes were achieved in the patients by surgical resection or treated with antifungal drug. Thirty-nine of 52 cases (75.00%)treated in our hospital were cured and 13 were improved(25.00%).Conclusion Although the clinical symptoms of primary pulmonary cryptococcosis were lack of specificity,the disease has some characteristics on radiology. Final diagnosis making depended on pathological examinations by lung biopsy. If diagnosis is timely and treatment is reasonable,majority of patients with the disease can be obtained satisfactory results.