肺隐球菌病九例分析

目的探讨肺隐球菌病临床特点、CT表现、病理所见及治疗方法。方法收集浙江大学附属邵逸夫医院自2002年1月至2004年8月经CT引导下经皮肺穿刺活检或手术病理证实的肺隐球菌病相关资料，进行回顾分析。结果本组病例共9例，男7例、女2例，年龄28～69岁，平均年龄44岁。人类免疫缺陷病毒抗体(HIV—Ab)均阴性。胸部CT扫描：8例表现为多发或单发的肺部结节和(或)肿块，1例表现为片状实变影。4例手术切除治疗，经手术病理证实；5例经CT引导下经皮肺穿刺活检病理证实。病理镜检均呈肉芽肿性改变，苏木精-伊红(HE)染色多核巨细胞内外可见大量隐球菌。5例单予抗真菌药物(氟康唑)治疗2．5～3．5个月，经半年至1年随访，肺部病灶基本吸收。结论肺隐球菌病CT表现主要为多发或单发的肺部结节和(或)肿块。经皮肺穿刺活检是很有价值的确诊手段。隐球菌肉芽肿为其病理特征。氟康唑具有良好抗新型隐球菌的活性，是合适的治疗选择。

Pulmonary cryptococcosis:analysis of nine cases

Objective To investigate the diagnosis and treatment of pulmonary cryptococcosis. Method A total of 9 cases of pulmonary cryptococcosis,diagnosed at Sir Run Run Shaw Hospital of Zhejiang University from January 2002 to August 2004,identified by pathological examinations,were retrospectively studied. Results The patients consisted of 7 males and 2 females aged from 28 to 69 years. Pulmonary nodules, either solitary or multiple,present in 8 of the 9 cases,were the most common CT finding. The diagnosis was confirmed in all cases by pathological study. The lung specimens of 5 cases were obtained by CT guided transthoracic needle aspiration lung biopsy,and these 5 cases were treated with fluconazole, after 0.5-1 year of follow-up, the pulmonary lesion essentially vanished. The other 4 cases were confirmed after surgery. Conclusions Most pulmonary cryptococcosis presented as pulmonary nodules or masses on CT,either solitary or multiple. Pathology was essential to the diagnosis. Fluconazole is active against cryptococcus neoformans,and appears to be effective in the treatment.