病理确诊免疫健全者原发肺隐球菌病32例回顾性分析

目的了解原发肺隐球菌病的临床特点，为临床诊治提供参考依据。方法回顾性分析2008年1月-2014年6月某医院32例经病理确诊的原发肺隐球菌病患者的临床资料。结果32例均为社区获得性感染，其中男性26例 ，女性6例 ，年龄17～62岁，平均(35.53±11.29)岁。32例病例中有基础疾病者8例，产妇2例，木工4例，养鸽者5例，从事海鲜运输者3例，潮湿环境生活者10例。肺部影像学表现为单发或多发结节、团块状影21例，大叶性实变2例，双肺弥漫性斑片状影5例，空洞3例，弥漫性混合性病变1例。病理确诊：经皮肺穿刺活检确诊23例，外科胸腔镜手术确诊7例，开胸手术确诊2例。预后：治愈30例，显效2例。结论原发肺隐球菌病多见于中青年免疫健全者，病隐匿，临床表现和影像学特点缺乏特异性，易被误诊漏诊；诊断困难，临床上缺乏快速简便确诊方法，有创性检查病理活检可作为确诊依据；治疗方法存在争议，氟康唑不良反应小，疗效好。

Retrospective analysis on pathological diagnosis of primary pulmonary cryptococcosis in 32 immunocompetent persons

ObjectiveTo understand clinical characteristics of primary pulmonary cryptococcosis (PPC), so as to provide reference for clinical diagnosis and treatment. MethodsClinical data of 32 patients who were confirmed PPC  by pathological diagnosis in a hospital from January 2008 to June 2014 were analyzed retrospectively.ResultsAll 32 cases were community acquired infection , 26  male and 6 female (age between 17 and 62 years old, the average age was （35.53 ± 11.29）.  Among 32 patients, 8 had underlying diseases, 2 were parturients, 4 were carpenters, 5 were pigeon keepers,3 were seafood  transport drivers,  and 10 lived in humid environment. Imaging findings：Solitary or multiple nodules and cluster shape(n=21），lobar consolidation(n=2），diffuse patchy shadow on bilateral lung (n=5），pulmonary cavity(n=3），and diffuse and mixed lesions (n=1）. Pathological confirmation: diagnosis through percutaneous  lung biopsy(n=23），thoracoscopic surgery(n=7），and thoracotomy(n=2）. Prognosis: 30 were cured，and 2 had marked effect. ConclusionPPC is commonly occurs in young and middle aged immunocompetent persons, the onset is occult, clinical manifestations and imaging features lack  specificity,  can be  easily misdiagnosed or omitted diagnosis, diagnosis is difficult, lack rapid diagnostic method in clinical practice, invasive pathological biopsy can be used as the basis of diagnosis; there is a controversy on therapy, adverse reaction of fluconazol is mild, and has good therapeutic effect.