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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2021年04期

页码:

436-441

栏目:

论著

出版日期:

2021-08-20

文章信息/Info

Title:

Clinical features and therapeutic analysis of pulmonary cryptococcosis in patients with non-immune deficiency

作者:

周 健¹; 蒋东坡¹; 王耀丽¹; 李 琦²

400042 重庆,陆军(第三)军医大学第三附属医院战创伤医学中心创伤、烧伤与复合伤国家重点实验室¹ 400037 重庆,陆军(第三)军医大学第二附属医院呼吸与危重症医学中心²

Author(s):

He Bingling¹;  Shao Shifeng¹;  Xiao Hong¹;  Song Qiaoling¹;  Tao Xuejiang¹;  Zhou Jian¹;  Jiang Dongpo¹;  Wang Yaoli¹;  Li qi².

¹Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing 400042,China; ²Respiratory and Critical Care Medicine Center, Xinqiao Hospital, Army Medical University, Chongqing 400037, China

关键词:

肺隐球菌病;  非免疫缺陷者;  临床特征

Keywords:

Pulmonary cryptococcosis;  Non-immune deficiency patients;  Clinical features

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2021.04.007

摘要:

目的 分析非免疫缺陷患者肺隐球菌病的临床特征及疗效。方法 回顾性分析陆军特色医学中心2017年1月至2020年6月确诊肺隐球菌病患者的病历资料39例,人口学资料,基础疾病,临床表现,影像学特征,病理检查结果,治疗方案和临床结局。收集患者肺组织病理学检测结果和痰液样本,分析是否存在隐球菌感染,对部分患者进行了隐球菌抗原检测,进行分析总结。结果 39例患者,男21例,女18例。20例(51.28%)体检发现肺部结节,19例(48.72%)有咳嗽、咳痰、发热临床症状,39例患者均确诊肺隐球菌病。32例(82.05%)行手术切除病变肺组织后辅助于抗真菌治疗药物,手术切除肺组织均行病理检查确诊隐球菌感染; 7例(17.95%)单纯抗真菌药物治疗者中,有3例行肺穿刺活检证实肺隐球菌,1例血清隐球菌荚膜多糖抗原测试呈阳性,1例痰液培养提示肺隐球菌,2例肺泡灌洗液检出隐球菌。随访中发现手术切除联合抗真菌治疗相比单纯药物抗真菌治疗者,疗程短。结论 非免疫缺陷肺隐球菌病患者的临床表现无特异性,检测血清或呼吸道标本中的隐球菌抗原或肺组织活检是确诊隐球菌感染的诊断手段。手术联合抗真菌药物是治疗隐球菌肺病的有效方法。

Abstract:

Objective To analyze the clinical features and efficacy of pulmonary cryptococcosis in patients with non-immune deficiency. Methods To retrospectively analyze the medical records of 39 patients with pulmonary cryptococcosis diagnosed from January 2017 to June 2020 at the Army Special Medical Center, and analyze the following data: demographic data, underlying diseases, clinical manifestations, imaging features, and pathological examination results, Treatment plan and clinical outcome. The lung histopathological test results and sputum samples of all patients were collected to analyze whether there was cryptococcal infection. Some patients were tested for cryptococcal antigen, and the above results were analyzed and summarized. Results The study analyzed 39 patients, 21 males and 18 females. Physical examination of 20 cases(51.28%)found pulmonary nodules, 19 cases(48.72%)had clinical symptoms of cough, sputum and fever, and 39 cases were diagnosed with pulmonary cryptococcosis. Among all patients, 32 cases(82.05%)underwent surgical removal of the diseased lung tissue followed by antifungal therapy, and pathological examination of the surgically removed lung tissue was performed to confirm cryptococcal infection; 7 cases(17.95%)were treated with antifungal drugs alone, 3 cases of lung biopsy confirmed pulmonary Cryptococcus, 1 case of serum Cryptococcus capsular polysaccharide antigen test was positive, 1 case of sputum culture showed Cryptococcus pneumoniae, 2 cases of alveolar lavage fluid detected Cryptococcus. During the follow-up, it was found that surgical resection combined with antifungal therapy had a lower risk of recurrence and a shorter course of treatment than those who were treated with drug antifungal therapy alone. Conclusion The clinical manifestations of patients with non-immune deficiency pulmonary cryptococcosis are not specific. Detection of cryptococcal antigens in serum or respiratory tract specimens or lung tissue biopsy is a diagnostic method to confirm cryptococcal infection. Surgery combined with antifungal drugs is an effective method for the treatment of cryptococcal pulmonary disease.

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备注/Memo

备注/Memo:

基金项目: 重庆市科卫联合医学科研项目(2021MSXM305 )
通信作者: 王耀丽, Email: wangylchen2005@aliyun.com
宋巧玲, Email: 380792566@qq.com

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更新日期/Last Update: 2021-08-20