中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

不同免疫状态肺隐球菌病 32 例临床分析

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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, and 5 patients (15.6%) in the immune-suppressed group. There were 9 patients (28.1%) involving lower lung in the immune-competent 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 immune-suppressed patients are mainly infiltrating shadow and mixed shadow. The treatment should be chose according to immune status.

关键词: 肺隐球菌病; 免疫状态; 影像学表现; 治疗

Key words: Pulmonary cryptococcosis; Immune state; Imaging findings; Treatment

引用本文: 张燕相, 董丽霞, 曹洁. 不同免疫状态肺隐球菌病 32 例临床分析. 中国呼吸与危重监护杂志, 2018, 17(4): 354-358. doi: 10.7507/1671-6205.201712023 复制

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1. 中国侵袭性肺部真菌感染工作组. 侵袭性肺部真菌感染的诊断标准与治疗原则 (草案). 中国实用内科杂志, 2006, 21(26): 1748-1751.
2. 邵长周, 瞿介明, 何礼贤. 免疫受损与非免疫受损患者并发肺结核的临床对照研究. 中国防痨杂志, 2002, 24(z1): 2-8.
3. Liu K, Ding H, Xu B, et al. Clinical analysis of non-AIDS patients pathologically diagnosed with pulmonary cryptococcosis. J Thorac Dis, 2016, 8(10): 2813-2821.
4. Brizendine KD, Baddley JW, Pappas PG. Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PLoS One, 2013, 8(3): e60431.
5. Hsu LY, Ng ES, Koh LP. Common and emerging fungal pulmonary infections. Infect Dis Clin North Am, 2010, 24(3): 557-577.
6. 梁丽玲, 梁志欣, 陈良安. 肺隐球菌病临床诊治进展. 中华医院感染学杂志, 2017, 27(6): 1437-1440.
7. 姚秀娟, 陈愉生. 29 例不同免疫状态肺隐球菌病临床分析. 临床肺科杂志, 2012, 17(3): 415-417.
8. Chang CC, Sorrell TC, Chen SC. Pulmonary cryptococcosis. Semin Respir Crit Care Med, 2015, 36(5): 681-691.
9. Kim DY, Kim Y, Baek SY, et al. Simultaneous thoracic and abdominal presentation of disseminated cryptococcosis in two patients without HIV infection. Am J Roentgenol, 2003, 181(4): 1055-1057.
10. 朱敏, 毕意辉, 武景波, 等. 肺隐球菌病临床误诊讨论. 临床误诊误治, 2015, 28(2): 43-46.
11. 赵宇, 蔡绍曦, 汪金林, 等. 90 例人类免疫缺陷病毒阴性宿主原发性肺隐球菌病的诊断分析. 中国呼吸与危重监护杂志, 2012, 11(6): 541-544.
12. Chang WC, Tzao C, Hsu HH, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest, 2006, 129(2): 333-340.
13. Zhang Y, Li N, Zhang Y, et al. Clinical analysis of 76 patients pathologically diagnosed with pulmonary cryptococcosis. Eur Respir J, 2012, 40(5): 1191-1200.
14. Xie LX, Chen YS, Liu SY, et al. Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients. Acta Radiol, 2015, 56(4): 447-453.
15. Yamakawa H, Yoshida M, Yabe M, et al. Correlation between clinical characteristics and chest computed tomography findings of pulmonary cryptococcosis. Pulm Med, 2015, 2015: 703407.
16. Kerkering TM, Duma RJ, Shadomy S. The evolution of pulmonary cryptococcosis: clinical implications from a study of 41 patients with and without compromising host factors. Ann Intern Med, 1981, 94(5): 611-616.
17. Slade E, Tamber PS, Vincent JL. The Surviving Sepsis Campaign: raising awareness to reduce mortality. Crit Care, 2003, 7(1): 1-2.
18. Pongmekin P, Chongtrakool P, Santanirand P, et al. Clinical characteristics and mortality risk factors of cryptococcal infection among HIV-negative patients. J Med Assoc Thai, 2014, 97(1): 36-43.
19. Mahabeer Y, Chang CC, Naidu D, et al. Comparison of Etests and Vitek 2® to broth microdilution for the susceptibility testing of Cryptococcus neoformans. Diagn Microbiol Infect Dis, 2014, 80(4): 294-298.
20. Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis, 2010, 50(3): 291-322.