免疫抑制和非免疫抑制患者肺隐球菌病临床特征分析

发布时间：2018-05-18 21:07

本文选题：隐球菌病 + 肺　；参考：《中国全科医学》2017年15期

【摘要】：目的探讨免疫抑制和非免疫抑制患者肺隐球菌病(PC)的临床特征,以期提高临床医师对本病的诊治水平。方法回顾性选取2008年1月—2015年12月于金华市人民医院住院的PC患者84例为研究对象。将患有AIDS、器官移植术后、长期使用糖皮质激素及免疫抑制药物的患者纳入免疫抑制组(43例),无以上疾病和未接受上述治疗的患者纳入非免疫抑制组(41例)。收集并比较两组患者一般资料、临床表现、辅助检查结果。结果免疫抑制组入院至确诊时间短于非免疫抑制组,住院时间长于非免疫抑制组,死亡率高于非免疫抑制组(P0.05)。免疫抑制组头痛、恶心呕吐、合并隐球菌脑膜炎发生率高于非免疫抑制组(P0.05)。免疫抑制组白细胞计数、血清清蛋白水平、血隐球菌荚膜多糖抗原阳性率、CD_3~+T淋巴细胞水平、CD_4~+T淋巴细胞水平低于非免疫抑制组(P0.05);免疫抑制组单发结节/肿块型病灶发生率低于非免疫抑制组,多发结节/肿块型病灶发生率高于非免疫抑制组(P0.05);免疫抑制组空洞征发生率高于非免疫抑制组,单侧肺受累发生率低于非免疫抑制组(P0.05)。结论免疫抑制患者PC更易合并中枢神经系统隐球菌感染,多以头痛、恶心呕吐为首诊原因,病死率较高,隐球菌荚膜多糖抗原阳性率较低,以多发结节/肿块型病灶、双侧肺受累为主,空洞征发生率较高;而非免疫抑制患者PC以单发结节/肿块型病灶、单侧肺受累为主。
[Abstract]:Objective to investigate the clinical features of pulmonary cryptococcosis (PCS) in immunosuppressive and non-immunosuppressive patients in order to improve the diagnosis and treatment of the disease. Methods 84 PC patients hospitalized in Jinhua people's Hospital from January 2008 to December 2015 were retrospectively selected. Patients with AIDS, organ transplantation, long-term use of glucocorticoid and immunosuppressive drugs were included in the immunosuppression group (n = 43), and patients without above disease and without above treatment were included in the non-immunosuppressive group (n = 41). To collect and compare the general data, clinical manifestations and auxiliary examination results of the two groups. Results the time from admission to diagnosis in immunosuppression group was shorter than that in non-immunosuppressive group, and the hospitalization time was longer than that in non-immunosuppressive group, and the mortality was higher than that in non-immunosuppressive group (P 0.05). The incidence of headache, nausea and vomiting and cryptococcal meningitis in immunosuppressive group was higher than that in non-immunosuppressive group (P 0.05). In immunosuppressive group, white blood cell count, serum albumin level, The positive rate of Cryptococcus perfringens polysaccharide antigen and the level of CD3 ~ T lymphocyte were lower than that of non-immunosuppressive group (P 0.05), and the incidence of single nodule / mass lesion in immunosuppressive group was lower than that in non-immunosuppressive group. The incidence of multiple nodule / mass lesion was higher than that of non-immunosuppressive group (P 0.05), the incidence of cavitation sign in immunosuppressive group was higher than that in non-immunosuppressive group, and the incidence of unilateral lung involvement was lower than that of non-immunosuppressive group (P 0.05). Conclusion PC in immunosuppressive patients is more likely to be associated with cryptococcal infection in the central nervous system, with headache, nausea and vomiting as the first reason, higher mortality, lower positive rate of Cryptococcus perfringens polysaccharide antigen, and multiple nodule / mass lesions. The incidence of cavitation sign was higher in both sides of lung than that in non-immunosuppressive patients with single nodule / mass lesion and unilateral lung involvement.
【作者单位】：浙江省金华市人民医院呼吸内科;
【分类号】：R519.4

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