非免疫缺陷者肺隐球菌病110例临床分析

目的探讨非免疫缺陷患者肺隐球菌病的临床特征、影像学表现、诊断和治疗，提高对本病的认识。方法对1995年1月至2012年6月本所确诊的110例非免疫缺陷肺隐球菌病患者进行回顾性研究，分析其临床特点。结果肺部隐球菌病以中青年（62例．56．4％）男性（82例，72．7％）多见。临床表现主要为咳嗽（67例，60．9％）、咳痰（43例。39．1％）、发热（21例．19．1％）、胸痛（21例，19．1％）、气促（21例，19．1％）、消瘦（11例，10．0％），亦可无症状（28例．25．5％）。胸部影像学表现为孤立性肿块影（26例，23．6％）、多发结节影（20例，18．204）、斑片实变影（33例，30．0％）、结节影与斑片影共存（31例，28．2％）。病变分布晕下肺多于中上肺（60．0％vs18．2％）、右肺多于左肺（39．1％vs32．7％）的特点．31例（28．2％）双肺均有病变。45例行血清隐球菌抗原乳胶凝集试验，阳性29例（64．4％），弱阳性2例（4．4％），阴性14例（31．1％）。全部病例均经病理确诊。手术切除病灶或足疗程抗真菌治疗可取得理想的疗效。结论肺隐球菌病多发生于无基础肺疾患的男性中青年．临床症状无特异性，影像学改变多样性，易被漏诊、误诊。疑似病例应行血清乳胶凝集试验、经纤维支气管镜或经皮肺穿刺活检确诊，手术切除及足疗程的抗真菌治疗可取得较好疗效。

Clinical analysis of pulmonary cryptococcosis in 110 immunocompetent patients

Objective To describe the clinical mainfestations, imaging, diagnosis, and management of pulmonary cryptococcosis in patients. Methods lt0 cases of pulmonary cryptoeoccosis diagnosed from January 1995 to June 2012 were reviewed. The clinical features were analyzed. Results Sixty-two cases （56.4%） out of 110 patients were under 50 years old and 80 cases （72.7%） were male. The main clinical mainfestations included cough （67 cases, 60.9%）,expectoration （43 cases, 39.1%）, fever （21 cases, 19.1%）, chest pain （21 cases, 19.1%）, dys＇pnea （21 cases, 19.1%）, emaciation （11 cases,10.0%）, and twenty-eight patients of entirely symptom free were hospitalized because of noticing shadows of the lung found by chest X film. The imaging features included solitary pulmonary mass opacity （26 cases, 23.6%）, nodular shadows （20 cases. 18.2%）, patchy consolidation opacity （33 cases, 30.0%）, combined patchy and nodular shadows （31 cases, 28.2%）. Lesion was found more in the lower than in the upper lung （60.0% vs 18.2%）, and more in the right than in the left lung （39.1% vs 32.7%）,and bilateral lung had lesion in 31 cases. The presence of cryptococcus was assessed in 45 patients using serum latex agglutination test against a cryptococcal antigen in serum. Twenty-nine patients were positive, two cases were weakly positive, and 14 cases were negative. All cases were diagnosed pathologically by lung resection or biopsy via fiberoptic bronchoscopy. Succeessful outcomes were achieved in the patients with lesion resection or venously administrated fluconazole and other antifungal agents. Conclusions Pulmonary cryptococcosis is found mainly in immunocompetent patients aged 〈50 years old without preexisting hmg disease, its clinical manifestation is not specific, the image is diverse, and it is often misdiagnosed or underdiagnosed. The suspected patients should be diagnozed by serum latex agglutination test, fibre bronchoscopy or percutaneous lung biopsy. Surgical removal of lesions or antifungal treatment for complete courses can lead to favorable outcomes for most patients.