原发性肺隐球菌病12例分析

目的：探讨肺隐球菌病的临床特征、诊断和治疗，以提高对本病的认识。方法：对1989年1月—2001年12月本所确诊的12例原发性肺隐球菌病进行回顾性研究，分析其临床特点。结果：肺部隐球菌病以中青年(8例，66．7％)和男性(9例，75．0％)多见。症状轻微，主要表现为咳嗽(7例，58．3％)，咳痰(6例，50．0％)，胸痛(4例，33．3％)，发热(3例，25．0％)，气促(2例，16．7％)和消瘦(2例，16．7％)，5例(41．7％)无症状。病变分布呈下肺(8例，66．7％)多于上肺(4例，33．3％)，右肺(6例，50．0％)多于左肺(3例，25．0％，余3例双侧)的特点。病变表现多为孤立性肿块影，共6例(50．0％)。全部病例均经病理确诊。手术切除病灶或足疗程氟康唑治疗可取得理想的效果。绪论：原发性肺隐球菌病多发于无基础肺疾患的中青年，以肺部阴影为主要表现，易被漏诊、误诊，足疗程氟康唑可取得很好疗效。

Primary pulmonary cryptococcosis:analysis of 12 cases

Objective: To investigate the clinical manifestations, diagnosis and management of primary pulmonary cryptococcosis. Methods: A retrospective analysis of clinical features was performed on 12 cases of primary pulmonary cryptococcosis diagnosed during 1989 to 2001. Results: Eight of 12 cases (66.7%) were under 50 years old and 9 (75.0%) were male patients. The main clinical manifestations were cough (7 cases, 58.3%), hemoptysis (6 cases, 50.0%), chest pain (4 cases, 33.3%), fever (3 cases, 25.0%), dyspnea (2 cases, 16.7%), emaciation (2 cases, 16.7%), five cases were entirely asymptomatic. Most patients were hospitalized because of pulmonary infiltrations in chest x ray film. Pulmonary lesions occurred mostly in lower field (8 cases,66.7%) with 6 in right side, 3 in left side and 3 bilateral. The diagnosis was confirmed in all cases by pathological findings. Succeessful outcomes were achieved in the patients by surgical resection or treated with fluconazole intravenous. Conclusions: Majority of patients with primary pulmonary cryptococcosis are under 50 years old without underlying pulmonary illness. Pulmonary infiltration is the main clinical manifestation. Primary pulmonary cryptococcosis is easy to be misdiagnosed. Satisfactory results can be obtained by long term fluconazole treatment.