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免疫健全与免疫缺损宿主肺隐球菌病的临床对比分析
Clinical Findings of Pulmonary Cryptococcosis in Immunocompetent and Immunocompromised Patients

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DOI:
作者:
李宁，李敏，万欢英
Ning Li, Min Li, Han-ying Wan
作者单位:
上海交通大学医学院附属瑞金医院呼吸科
Department of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
关键词:
肺；隐球菌病；免疫状态；临床表现
Lung；Cryptococcosis；Immune state；Clinical feature
摘要:
目的 探讨不同免疫状态患者肺隐球菌病的临床特点。 方法 收集上海市瑞金医院2002年8月至2012年8月经病理确诊的39例肺隐球菌病患者临床资料，分别对免疫健全和免疫缺损患者进行对比分析。 结果 所有患者均HIV抗体阴性，其中免疫健全组20例，免疫缺损组19例。首发症状依次为咳嗽、咳痰和发热，其中13例（33.3%）为无症状患者。免疫健全组CT影像上以结节团块影为主（75%），而免疫缺损组多见双肺弥漫混合病变(42.1%)，并可见空洞形成。12例患者进行手术治疗，22例患者接受抗真菌单用药物治疗，其中免疫健全组10例，免疫缺损组12例。免疫健全组患者症状改善及病灶吸收早于免疫缺损组，无死亡病例。 结论 肺隐球菌病可发生在免疫健全宿主；临床和影像学缺乏特征性，并与患者免疫状态有关；诊断主要有赖于病理学检查；治疗可根据不同患者免疫状况，免疫健全的肺隐球菌病患者预后良好。
Objective To analyze the clinical manifestations, radiology, diagnosis and treatment of pulmonary cryptococcosis (PC) in patients under different immune states. Methods A total of 39 cases of PC, confirmed by pathological examinations at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Aug 2002 to Aug 2012, were retrospectively studied. Clinical data, CT findings and treatment of different immune status were analysised respectively. Results All of the cases were non-AIDS, of whom 20 were immunocompetent and 19 were immunocompromised. The early symptoms were cough, phlegm and fever. There were 13 patients (33.3%) who remained asymptomatic. Pulmonary nodules/mass-like opacities were the most frequent radiological abnormality in immunocompetent patients (75%) and diffuse mixed pattern and cavity were present in the immunocompromised group (42.1%). Surgical resection was performed in 12 patients and antifungal single therapy was adopted in 22 cases, including 10 immunocompetent subjects and 12 immunocompromised subjects. There were more subjects with improvement in symptoms and resolution of lesions in immunocompetent group compared with immunocompromised group. The dieasease was cured in all the cases. Conclusions Immunocompetent patients can suffer from PC. PC does not have any specific clinical manifestations and image findings, and it is related with the immune status of patients. The correct diagnosis mainly relies on histopathological examination. More reasonable treatments of PC should be adopted according to patients’ immune status, and better prognosis seems to be in favor of immunocompetent subjects.

 

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