肺隐球菌病2例报道并文献复习

发布时间：2018-08-26 16:28

【摘要】：目的探讨肺隐球菌病的临床特点及胸部CT特征性表现,提高医师对肺隐球菌病的认识水平及早期确诊率。方法回顾我院呼吸内科自2011年-2016年确诊的2例肺隐球菌病患者的病例资料,并结合中国知网网络出版总库近10年内收录的国内肺隐球菌病相关文献资料经筛选后的432例肺隐球菌病共同进行综合分析,总结肺隐球菌病的发病人群、易感因素、临床表现、胸部CT影像学特点、诊断手段、误诊类型及误诊原因。结果(1)入选文献98篇,结合我科确诊的2例临床资料,共计肺隐球菌病患者434例,男女比例为1.95:1,80.6%(204/253)的肺隐球菌病患者无明确的鸟类、家禽及土壤等接触史,65.8%(244/371)患者否认基础疾病史,26.0%(113/434)患者无任何自觉症状,余以咳嗽咳痰、胸痛、发热等非特异性症状就诊。(2)胸部CT表现中结节影或团块影占73.7%,斑片状浸润影或实变影占15.0%,混合型病变占10.1%,弥漫粟粒影5例,占1.2%。(3)常见误诊疾病依次为肺癌或肺部转移瘤147例(49.4%),普通细菌性肺炎68(23.0%)例,肺结核55例(18.6%)。(4)97.9%的患者(426/434)通过经皮肺穿刺、开胸手术、支气管镜活检、胸腔镜肺叶切除或活检标本的病理组织学确诊,少数为呼吸道分泌物或血液、脑脊液等体液标本病原学确诊。结论1、近10年的文献回顾分析发现,PC在免疫功能“正常”的患者中并不少见,尤其中青年男性,多数患者无明确接触史。2、PC分布存在地区差异,在国内南方发病多于北方。3、PC患者的临床表现缺乏特异性,胸部病变以肺外带、肺下叶多见,病灶形态各异,结节性肿块在免疫功能正常患者中较为常见。4、经皮肺穿刺活检术在肺隐球菌病诊断中占有重要地位,隐球菌乳胶凝集试验具有较高的特异性及灵敏性,可作为PC的早期筛查检查及疗效评估指标。
[Abstract]:Objective to investigate the clinical features and chest CT features of pulmonary cryptococcosis and to improve the understanding level and early diagnosis rate of pulmonary cryptococcosis. Methods the data of 2 cases of pulmonary cryptococcosis diagnosed in Department of Respiratory Medicine from 2011 to 2016 were retrospectively reviewed. Combined with 432 cases of pulmonary Cryptococcosis collected in China's General Library of Web Publishing in recent 10 years after screening, the incidence population, susceptible factors and clinical manifestations of pulmonary Cryptococcus pneumoniae were summarized, and a comprehensive analysis was carried out on 432 cases of pulmonary Cryptococcus pneumoniae after screening, and summarized the incidence population, susceptible factors and clinical manifestations of pulmonary Cryptococcus pneumoniae. Chest CT imaging features, diagnostic methods, types of misdiagnosis and causes of misdiagnosis. Results (1) A total of 434 patients with pulmonary Cryptococcus pneumoniae were included in 98 articles of literature and 2 cases confirmed in our department. There were no definite birds in lung Cryptococcus pneumoniae patients whose male and female ratio was 1.95: 1% (204 / 253). 65.8% (244 / 371) of patients with history of contact with poultry and soil denied that 26.0% (113 / 434) of patients with underlying diseases had no conscious symptoms and had cough, sputum and chest pain. Fever and other nonspecific symptoms. (2) in chest CT, nodular shadow or mass shadow accounted for 73.7%, macular infiltrating shadow or solid shadow accounted for 15.0%, mixed lesion accounted for 10.1%, diffuse miliary shadow in 5 cases. (3) the most common misdiagnosed diseases were lung cancer or pulmonary metastases (49.4%), common bacterial pneumonia (68 cases) (23.0%), pulmonary tuberculosis (55 cases (18.6%). (4) 97.9% (42.6%) patients (42.6% 434) by percutaneous lung puncture, thoracotomy, bronchoscopy biopsy. The histopathological diagnosis of thoracoscopic lobectomy or biopsy was confirmed, and a few samples of respiratory tract secretion, blood and cerebrospinal fluid were confirmed by etiology. Conclusion 1. The retrospective analysis of the literature in the past 10 years showed that the distribution of PC was not uncommon in the patients with normal immune function, especially in young and middle-aged men, and most of the patients had no definite contact history and the distribution of PC was different in different regions. The clinical manifestations of the patients with PC in the south of China are more than those in the north. The chest lesions are extrapulmonary, the lower lobes of the lungs are more common, and the lesions are different in shape. Nodular mass is more common in patients with normal immune function. Percutaneous pulmonary biopsy plays an important role in the diagnosis of pulmonary cryptococcosis. The latex agglutination test of Cryptococcus has high specificity and sensitivity. It can be used as an index of early screening and curative effect evaluation of PC.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R519.4

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