隐球菌抗原检测（胶体金法）对肺隐球菌病临床应用的回顾性分析

发布时间：2018-01-23 01:58

  本文关键词： 肺隐球菌病 胶体金法 新生隐球菌　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:近年来,肺隐球菌病(PC)的发病率有增加的趋势,因其临床表现、肺部影像特征缺乏特异性,有创的病理检查不易被接受,而病原学检出率低,诊断较为困难,故多采用隐球菌抗原的免疫学检查作为辅助手段。然而国内外对隐球菌抗原的研究多集中在乳胶凝集实验法,很少研究胶体金法在肺隐球菌病诊断的临床意义。目的:研究胶体金法在PC诊断的敏感性及特异性,从而评价在缺乏病理支持情况下,其对肺隐球菌病诊断的临床意义,同时对诊断为PC患者的临床特征进行归纳,为临床医生提高对PC的认识及早期诊治提供帮助。研究对象与方法:收集吉林大学第二医院从2014年12月1日到2016年12月31日期间怀疑PC且行胶体金法的所有住院患者的临床资料,统计胶体金法诊断PC的敏感性及特异性,并对诊断为PC患者的一般资料、临床症状及体征、影像学表现、辅助检查、入院初步诊断及治疗与预后进行回顾性分析。结果:1.胶体金法结果:行胶体金法的患者共131例,其中阳性19例,阴性112例。阳性的19例患者中,13例为PC,6例为非PC;112例阴性患者均为非PC。胶体金法的敏感性为100%,特异性为94.92%,阳性预计值68.42%,阴性预计值100%。2.临床特征:13例PC患者男女比例1.6:1,以50-60岁年龄段居多,均否认隐球菌接触史,仅1例有污水接触史。无基础疾病的占46.15%。有基础疾病的占53.85%。主要表现为:咳嗽(69.23%)、咳痰(46.15%)、发热(23.08%)、胸痛(15.38%)、气短(15.38%)、咯血(15.38%)、盗汗(7.69%)、体重减轻(7.69%)、乏力(7.69%)中的一种或多种症状。影像学表现为结节/肿块型有6例(46.14%),实变型有2例(15.38%),混合型有5例(38.47%)。病灶呈单发的有3例(23.07%),多发的有10例(76.93%)。病灶局限于单侧肺的有8例(61.52%),双侧肺的有5例(38.48%)。病灶靠近肺野外周部的有11例(84.62%),中央部的有2例(15.38%)。伴随征象有空泡征(38.46%)、毛刺(38.46%)、肺门或(和)纵膈淋巴结肿大(38.46%)、胸膜肥厚(38.46%)、晕征(23.08%)、支气管充气征(23.08%)、空洞(15.38%)、分叶(7.69%)、胸腔积液(7.69%)。早期误诊率高达69.23%。随访时间20天到18个月不等,结果为3例失访,1例治愈,6例明显好转,3例好转。结论:1.本研究中胶体金法的敏感性为100%,特异性为94.92%,阳性预计值68.42%,阴性预计值100%,并且其常温下性状稳定,操作简单,10分钟即可出结果,结果判定简单,因此,胶体金法对肺隐球菌病具有较高的诊断及鉴别诊断价值,尤其可作为隐球菌感染的筛查方法,以及作为隐球菌感染的排除诊断方法。2.肺隐球菌病多见于免疫功能低下或免疫功能受损患者,但免疫功能正常的患者所占比例也相对较高,不容忽视。3.肺隐球菌病患者男性多于女性,好发于50-60年龄段,多数患者无明确鸟禽类粪便等各类接触史。临床表现缺乏特异性,以咳嗽最为常见,早期误诊率较高。肺部影像学主要表现为:结节/肿块型、实变型、混合型三种。以结节/肿块型为主,多发病变常见,多局限于单侧肺,以靠近肺野外周部多见,可伴随空泡征、毛刺、胸膜增厚等征象。4.肺隐球菌病的抗真菌治疗疗程较长,目前尚无准确的抗真菌治疗终点。
[Abstract]:Background: in recent years, pulmonary cryptococcosis (PC) the incidence rate is increasing, due to its clinical manifestations, imaging features of pulmonary pathology are lack of specificity, and is not easy to be accepted, and the pathogen detection rate is low, the diagnosis is difficult, so the cryptococcal antigen immune examination as an auxiliary means. However, the domestic and foreign research on cryptococcal antigen is more concentrated in the latex agglutination test method, colloidal gold method little research on clinical significance in the diagnosis of pulmonary cryptococcosis. Objective: To study the colloidal gold method in sensitivity and specificity of PC diagnosis, and evaluation on the lack of support for the pathological condition, clinical significance the diagnosis of pulmonary cryptococcosis, at the same time for the diagnosis of clinical characteristics of patients with PC induction for clinicians to raise awareness and help to early diagnosis and treatment of PC. Subjects and methods: the second hospital of Jilin University were collected from December 1, 2014 to 2016 During the year December 31st with suspected PC and colloidal gold method for all hospitalized patients with clinical data, sensitivity and specificity of statistical colloidal gold method for diagnosis of PC, and the diagnosis of the general information of patients with PC, clinical symptoms and signs, imaging manifestation, auxiliary examination, preliminary diagnosis and treatment and prognosis were retrospectively analyzed in hospital. Results: 1. colloidal gold method results: colloidal gold with a total of 131 cases, including 19 cases of positive and negative in 112 cases. In 19 positive patients, 13 cases were PC, 6 cases of non PC; the sensitivity of the 112 negative cases were non PC. colloidal gold method was 100%, the specificity was 94.92%, positive predictive value 68.42%, the negative predictive value of clinical features of 100%.2.: 13 cases of patients with PC male to female ratio of 1.6:1, with 50-60 years of age are denied cryptococcal contact history, only 1 cases have water contact history. No basic diseases accounted for the main performance of 53.85%. 46.15%. disease: cough 鍡，

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