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不同免疫状态肺隐球菌病32例临床分析

Clinical analysis of pulmonary cryptococcosis with varied immune status: 32 cases review
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摘要 目的探讨肺隐球菌病患者的免疫状态与临床特点的相关性。方法回顾性分析2001年8月至2017年10月在天津医科大学总医院确诊为人类免疫缺陷病毒阴性的32例肺隐球菌病患者的临床资料。按照肺隐球菌病易患因素将32例患者分成免疫正常组(13例)和免疫低下组(19例)。比较在不同免疫状态下的两组患者的临床特点。结果 32例患者全部因有临床症状就诊,咳嗽最为常见,其次为咳痰、发热、胸闷、胸痛、咯血等,两组间差异无统计学意义。胸部CT显示病变累及肺上叶的免疫正常组2例(6.3%),免疫低下组5例(15.6%),累及肺下叶的免疫正常组9例(28.1%),免疫低下组12例(37.5%);病变形态为结节肿块型的免疫正常组10例(31.3%),免疫低下组0例;病变表现为浸润型的免疫正常组1例(3.1%),免疫低下组8例(25.0%);病变呈混合型的免疫正常组2例(6.3%),免疫低下组11例(34.4%)。32例患者中有5例并发隐球菌脑膜炎,其中2例伴有嗜酸性粒细胞水平升高。结论免疫状态不同时两组患者的临床表现无特异性。免疫正常组胸部CT主要表现为结节肿块型,免疫低下组主要表现为浸润型和混合型。根据患者免疫状态合理选择治疗方案。 Objective To discuss the correlation between immune status and clinical characteristics in pulmonary cryptococcosis. Methods The clinical data of 32 non-AIDS patients with pulmonary cryptococcosis,diagnosed from August 2001 to October 2017 in Tianjin Medical University General Hospital, were retrospectively analyzed. The enrolled patients were divided into an immune-competent group with 13 cases and an immune-suppressed group with 19 cases. The clinical characteristics were compared between the two groups with different immune status.Results All 32 patients were treated for clinical symptoms. The main symptoms were cough, expectoration, fever, chest tightness, chest pain, and hemoptysis. There were no statistical differences between the two groups. The computed tomography of chest showed that there were 2 patients(6.3%) involving upper lung in the immune-competent group, and5 patients(15.6%) in the immune-suppressed group. There were 9 patients(28.1%) involving lower lung in the immunecompetent group, and 12 patients(37.5%) in the immune-suppressed group. There were 10 patients(31.3%) with nodular masses of lesions in the immune-competent group and none in the immune-suppressed group. There was 1 patient with infiltrating in the immune-competent group and 8 patients in the immune-suppressed group. There were 2 patients with mixed types of lesions in the immune-competent group and 11 patients in the immune-suppressed group. Five patients were complicated with cryptococcal meningitis, and 2 patients with eosinophilia. Conclusions The clinical characteristics of the patients with pulmonary cryptococcosis are not specific in difference immune status. The chest CT shows that the lesions of immune-competent patients are mainly nodular masses type, while lesions of immunesuppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.
作者 张燕相 董丽霞 曹洁 ZHANG Yanxiang, DONG Lixia, CAO Jie( Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P. R. China)
出处 《中国呼吸与危重监护杂志》 CSCD 北大核心 2018年第4期354-358,共5页 Chinese Journal of Respiratory and Critical Care Medicine
关键词 肺隐球菌病 免疫状态 影像学表现 治疗 Pulmonary cryptococcosis Immune state Imaging findings Treatment
作者简介 通信作者:董丽霞,Email:luckydonglixia@163.com
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