未见明显免疫功能低下的11例肺隐球菌病临床特征分析并文献复习

中国真菌学杂志　 2018, Vol. 13 　Issue (3): 148-151,163.

未见明显免疫功能低下的11例肺隐球菌病临床特征分析并文献复习

王艳玲¹, 阳昱恒², 于农¹, 邓淑文¹

1. 苏州高新区人民医院, 苏州 215129;
2. 中国人民解放军武汉总医院, 武汉 430070

收稿日期:2017-10-26 出版日期:2018-06-28 发布日期:2018-06-28
通讯作者: 邓淑文,E-mail:danyanghhh@qq.com;于农,E-mail:yunong78612@sina.com E-mail:danyanghhh@qq.com;yunong78612@sina.com
作者简介:王艳玲,女(汉族),本科,副主任医师.E-mail:wyd_wjq1992@163.com

Clinical characteristics on 11 immunocompetent patients with pulmonary cryptococcosis and literature review

WANG Yan-ling¹, YANG Yu-heng², YU Nong¹, DENG Shu-wen¹

1. People's Hospital of Suzhou National New & Hi-Tech Industrial Development Zone, Suzhou 215129, China;
2. Chinese Military Wuhan General Hospital, Wuhan 430070, China

Received:2017-10-26 Online:2018-06-28 Published:2018-06-28

摘要/Abstract

摘要：

目的分析11例未见明显免疫功能低下的肺隐球菌病患者的临床特征并文献复习。方法回顾分析2004年1月~2016年12月经病理或病原学确诊为肺隐球菌病11例患者临床资料。结果 11例患者均未见明显免疫功能低下，值得注意的是，其中7例患者（63.6%）有肥胖、高血压、冠心病等基础病，1例有20多年吸烟史，只有1例是体检发现。6例初诊误诊，误诊率为54.54%（6/11），最易被误诊为肺癌（5/6）。较少累及肺外器官。影像学表现以两中下肺单发结节最多见，以肺外周，胸膜下为显著；斑片样渗出影相对较少；10例结节或肿块边缘均有晕征。胸膜反应性增厚或胸膜牵拉7例，周围有毛刺和粗条索的8例；空洞及空腔各1例。11例PC患者中，9例经病理确诊，2例经肺穿刺液涂片找到隐球菌。结论免疫正常PC患者以男性青壮年多发，高血压、肥胖、冠心病、吸烟者为高发人群，影像学以肺下部单发结节多见，结节周围常常有晕征，不光滑。空洞及空腔少见。罕见累及肺外器官，初诊易误诊为肺癌。诊断主要依赖于病理组织学检查。

关键词: 肺, 隐球菌病, 免疫功能健全, CT表现

Abstract:

Objective To investigate the clinical characteristics of PC in 11 immunocompetent patients. Methods Eleven PC cases diagnosed histopathologically and mycologically from January 2004 to December 2016 were investigated retrospectively. General clinical data, radiology, way of diagnosis were analyzed. Results Eleven patients were immunocompetent. Seven PC patients (63.6%) had obesity, hypertension or coronary heart disease; one patient had smoking history for 20 years; only one case was found during checkup. Six cases were misdiagosised (54.54%,6/11), carcinoma of lung was the most misdiagnosised disease. The most common CT finding in those patients with pulmonary cryptococcosis was pulmonary solitary nodules with halo sign in middle and lowerlung predominance. Areas of hazy increased attenuation, and areas of cavitation were uncommon. Nine of 11 PC patients were diagnosised by histopathological examination; 2 of them found the Cryptococcus spp. in ink KOH test; one had positive serum cryptococcal antigen (CrAg). Conclusion PC could occurred in immunocompetent individuals with obesity, hypertension or coronary heart disease. Smoking could also be a risk factor. CT commonly demonstrated pulmonary solitary nodules in middle and upper lung. Definitive diagnosis could be made histopathologically. Better diagnostic outcomes could be achieved by bronchoscopy, bronchoalveolar lavage/trans-bronchial biopsy, or via thoracotomy-directed biopsy.

Key words: immunocompetent, pulmonary, cryptococcosis, radiology

中图分类号:

R519.4

王艳玲, 阳昱恒, 于农, 邓淑文. 未见明显免疫功能低下的11例肺隐球菌病临床特征分析并文献复习[J]. 中国真菌学杂志, 2018, 13(3): 148-151,163.

WANG Yan-ling, YANG Yu-heng, YU Nong, DENG Shu-wen. Clinical characteristics on 11 immunocompetent patients with pulmonary cryptococcosis and literature review[J]. Chinese Journal of Mycology, 2018, 13(3): 148-151,163.

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