有无基础疾病对肺隐球菌病临床特点的影响

发布时间：2018-05-15 07:16

本文选题：肺隐球菌病 + 流行病学　；参考：《天津医科大学》2017年硕士论文

【摘要】：研究目的:搜集1999年至2016年年间天津市多家医院收治的确诊肺隐球菌病的75名患者进行统计学对比,以分析宿主因素的不同对隐球菌感染患者临床特点的影响。研究内容与方法:将75例肺隐球菌病患者分成有基础疾病组和无基础疾病组,对比分析两组患者的性别、年龄分布,既往有无鸽子接触史,临床表现,实验室化验指标、乳胶凝集试验结果、胸部影像学表现等。研究结果:自1999年至2016年肺隐球菌病患者呈逐年上升趋势。无基础疾病组和有基础疾病组分别占43例、32例,其中男女各占42、33例,两组患者无性别分布差异(P=0.579)。年龄均在23-76岁之间,平均年龄48.72±10.23,两组患者好发年龄段均在41-50岁之间,其中有基础疾病者平均年龄51.06±10.22,无基础疾病者平均年龄46.98±10.00,两组发病年龄无统计学差异(P=0.887)。有鸽子接触史的占25例(33.3%),两组患者无统计学差异。该病常见的临床表现有咳嗽、发热、咳痰、胸闷、胸痛,少见有气短、咯血,无症状患者两组无统计学差异(P=0.133),有基础疾病者出现发热的更多见(P=0.010),无基础疾病者出现咳嗽的更多见(P=0.043)。白细胞计数、中性粒细胞比值、血沉、降钙素原等在无基础疾病和有基础疾病两组患者并无统计学差异(P值分别为0.28,0.065,0.274,0.073),C反应蛋白在两组患者中的差异有统计学意义(P=0.019)。56例患者接受隐球菌血清荚膜多糖乳胶凝集试验的检测,阳性者51例(91.1%),阴性者5例(8.9%),两组患者在血清荚膜多糖乳胶凝集试验检测上无差异(P=0.062)。累及两侧肺的有30例(40.0%),累及单侧肺的占45例(60.0%),两组患者具有统计学差异(P=0.012);病灶单发者25例(33.3%),多发者50例(66.7%),两组患者无统计学差异(P=0.141);累及胸膜下的患者有38例(50.7%),无基础疾病者更易累及胸膜下,二组患者具有统计学意义(P=0.041)。结节肿块型26例(34.7%),是75例患者中出现最多的影像学表现,也是无基础疾病患者中出现最多的,二者具有统计学差异(P=0.011),单纯发生浸润型改变的有25例(33.3%),混合型22例(29.3%),是有基础疾病患者中出现最多的影像学表现,两组患者表现出统计学差异(P=0.018)。胸腔积液、晕征、牵拉支气管扩张、含气支气管征、空洞等影像学伴随征象于两组患者之间无统计学差异(P0.05)。结论:肺隐球菌病患病率呈逐年上升的趋势,好发于中青年男性,一部分患者具有鸽子接触史,但不能单纯凭借接触史排除或确定隐球菌感染的可能性;无基础疾病者患病率逐渐高于有基础疾病者,除结核、乙肝、HIV外,合并支气管哮喘、慢性阻塞性肺病等原发基础肺部疾病者更应注意有无隐球菌感染的可能;肺隐球菌病的临床表现非特异,部分患者无症状,而发热、咳嗽分别于有基础疾病者和无基础疾病者更易出现;隐球菌血清乳胶凝集试验对于评估隐球菌感染具有较高的特异性和敏感性;无基础疾病者多见胸膜下、合并晕征、含气支气管征的结节肿块型的影像学表现,合并基础疾病者多见混合型病变及间质性病变。
[Abstract]:Objective: to collect and compare 75 patients with confirmed pulmonary cryptococcosis in Tianjin from 1999 to 2016 to analyze the effects of different host factors on the clinical characteristics of cryptococcal infection. Research contents and methods: 75 cases of pulmonary cryptococcosis were divided into basic disease group and non basic disease. Group, compared and analyzed the sex, age distribution of the two groups, the history of dove contact, clinical manifestations, laboratory test indicators, the results of latex agglutination test and chest imaging. The results of the study: from 1999 to 2016, the patients with pulmonary cryptococcosis were increasing year by year. There were 43 cases in the non basic disease group and 32 cases with basic disease, 32 cases respectively. Among them, male and female accounted for 42,33 cases, and the two groups had no difference in sex distribution (P=0.579). The age was 23-76 years old, the average age was 48.72 + 10.23. The two groups of patients with good onset age were 41-50 years old. The average age of the patients with basic diseases was 51.06 + 10.22, the average age of those without basic diseases was 46.98 + 10, and there was no statistical difference in the age of onset of the disease in the two groups. (P=0.887) 25 cases (33.3%) with dove contact history. There was no statistical difference between the two groups. The common clinical manifestations of the disease were cough, fever, expectoration, chest tightness, chest pain, two groups of patients without symptoms of shortness of breath, hemoptysis, and asymptomatic group (P=0.133). There were more fever in patients with basic disease (P=0.010), and coughing without basic disease. More see (P=0.043). Leukocyte count, neutrophils ratio, erythrocyte sedimentation rate, calcitonin, and other two groups of patients without basic disease and basic disease (P value 0.28,0.065,0.274,0.073), C reactive protein in the two groups of patients with statistical significance (P=0.019).56 patients accepted Cryptococcus sera serum capsule The test of sugar latex agglutination test showed that 51 cases (91.1%) were positive and 5 cases (8.9%) were negative. There were no difference between the two groups in the serum capsule polysaccharide latex agglutination test (P=0.062). 30 cases (40%) involving bilateral lung, 45 cases involving unilateral lung (60%) and two groups (P=0.012), 25 cases (33.3%) in single lesion (33.3%). There were 50 cases (66.7%). There were no statistical differences in the two groups (P=0.141); 38 patients (50.7%) involved under the pleura, and those without basic diseases were more likely to be under the pleura, and the two groups were statistically significant (P=0.041). 26 cases of nodular mass (34.7%) were the most common imaging manifestations in 75 patients, and were the most common patients without basic diseases. The two had statistical difference (P=0.011), 25 cases (33.3%) and 22 cases of mixed type (29.3%) were the most important imaging manifestations in the patients with basic disease. The two groups showed statistical difference (P=0.018). Pleural effusion, halo sign, stretch bronchiectasis, gas bronchiectasis, cavity and other imaging accompanying There was no statistical difference between the two groups of patients (P0.05). Conclusion: the prevalence rate of pulmonary cryptococcosis is increasing year by year, good for young and middle-aged men, some patients have dove contact history, but can not simply rely on contact history to exclude or determine the possibility of cryptococcus infection; the prevalence rate of non basic diseases is gradually higher than that of basic diseases. In addition to tuberculosis, hepatitis B and HIV, patients with primary underlying lung diseases such as bronchial asthma and chronic obstructive pulmonary disease should be more aware of the possibility of cryptococcus infection; the clinical manifestations of pulmonary cryptococcosis are nonspecific, some patients are asymptomatic, fever, and cough of Yu Youji base disease and non basic disease are more likely to occur; Cryptococcus sera The latex agglutination test has a high specificity and sensitivity for the evaluation of cryptococcus infection. Those without basic diseases are mostly under the pleura, combined with halo sign and bronchoid nodular mass, with mixed lesions and interstitial lesions in the patients with basic diseases.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519.4

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