中国真菌学杂志2024,Vol.19Issue(6) :613-618,644.

45例非HIV感染者肺隐球菌病临床特征和CT分析

Clinical features and CT analysis of 45 cases of pulmonary cryptococcosis in HIV-uninfected patients

蔡仁慧 王英
中国真菌学杂志2024,Vol.19Issue(6) :613-618,644.

45例非HIV感染者肺隐球菌病临床特征和CT分析

Clinical features and CT analysis of 45 cases of pulmonary cryptococcosis in HIV-uninfected patients

蔡仁慧 1王英2
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作者信息

  • 1. 福建医科大学省立临床医学院,福建省立医院皮肤科,福州大学附属省立医院,福州 350000
  • 2. 上海长海医院皮肤科,上海 200433
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摘要

目的 本研究旨在探讨非HIV感染肺隐球菌病患者的临床特征和影像学特点,以减少漏诊和误诊.方法 回顾性分析2021年1月—2023年12月在我院确诊的肺隐球菌病患者的临床与影像学资料.结果 共纳入了45例非HIV感染肺隐球菌病患者,平均年龄(55.47±15.31)岁,其中男性22例.免疫功能低下组共16例,平均年龄(60.38±11.59)岁,显著高于29例免疫功能正常组的(33.34±9.53)岁(P<0.0001).无症状者占42.22%(19例).高分辨率计算机断层扫描显示,病变形态以单发结节为主(34/45例),病变部位以左肺下叶最多(22例,占48.89%),其次为右肺下叶(15例,占33.33%)和右肺上叶(11例,占24.44%).经皮CT引导下肺穿刺组织病理学检查确诊阳性率为100%(15/15例).肺组织隐球菌培养阳性率为70%(7/10例),高于肺泡灌洗液.结论 非HIV感染肺隐球菌病的临床表现缺乏特异性,对于临床上高度怀疑的患者,推荐首选经皮CT引导下肺穿刺进行肺组织真菌培养和病理学检查.

Abstract

Objective This study aims to explore the clinical and radiological characteristics of non-HIV-infected patients with pulmonary cryptococcosis in order to reduce missed diagnosis and misdiagnosis.Methods The clinical and imaging data of patients with pulmonary cryptococcosis diagnosed in our hospital from January 2021 to December 2023 were retrospective-ly analyzed.Results A total of 45 non-HIV-infected pulmonary cryptococcosis patients were included,including 22 males with an average age of 55.47±15.31 years old.There were 16 patients in the immunocompromised group,with an average age of 60.38±11.59 years old,which was significantly higher than the 33.34±9.53 years old in the immunocompromised group (P<0.0001).Asymptomatic patients accounted for 42.22% (19 cases).High-resolution computed tomography (HRCT) showed that the lesions were mainly single nodules (34/45 cases),and the lesions were most frequently located in the lower lobe of the left lung (22 cases,accounting for 48.89%),followed by the lower lobe of the right lung.(15 cases,accounting for 33.33%) and the upper lobe of the right lung (11 cases,accounting for 24.44%).The positive rate of con-firmed diagnosis by histopathological examination of lung puncture under percutaneous CT guidance was 100% (15/15 ca-ses).The positive rate of cryptococcal culture in lung tissue was 70% (7/10 cases),which was higher than that in alveolar lavage fluid.Conclusion The clinical manifestations of non-HIV-infected pulmonary cryptococcosis lack specificity.For pa-tients with high clinical suspicion,percutaneous CT-guided lung puncture for lung tissue fungal culture and pathological ex-amination is recommended as the first choice.

关键词

肺隐球菌病/真菌感染/高分辨率CT/新生隐球菌/非HIV感染

Key words

pulmonary cryptococcosis/fungal infection/high-resolution CT/Cryptococcus neoformans/non-HIV infec-tions

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出版年

2024
中国真菌学杂志
上海长征医院

中国真菌学杂志

CSTPCDCSCD
影响因子:0.557
ISSN:1673-3827
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