50例隐球菌血症的临床与预后分析

目的探讨不同免疫状态人群隐球菌血症的临床特点。方法对浙江大学医学院附属第一医院（2002年12月至2014年3月）50例隐球菌血症的临床资料进行回顾性分析,根据患者自身免疫情况分成免疫缺陷组（41例）和免疫健全组（9例）,对研究病例的性别、发病年龄、临床表现、实验室检查、抗真菌药物及疗效进行分析。结果 50例隐球菌血症中男性30例,女性20例,年龄15~83岁,平均（49±17.0）岁;43例有不同程度发热表现,性别、年龄、平均住院时间、临床表现、白细胞、中性粒细胞比例、C反应蛋白、尿素氮等在两组中差异无统计学意义,免疫缺陷组患者合并隐球菌性脑膜炎、同时合并隐球菌性脑膜炎及肺隐球菌病的病例高于免疫健全组。住院期间死亡10例,病情恶化13例,好转27例。结论隐球菌血症的临床表现不典型,免疫缺陷组较免疫健全组易引起隐球菌血症,免疫缺陷组更易合并隐球菌性脑膜炎及肺隐球菌病,隐球菌血症的预后差。

The clinical and prognostic analysis of 50 patients with cryptococcemia

Objective To investigate clinical characteristics of cryptococcemia patients under different immunological status. Methods A retrospective study was carried out to analyze the medical records of 50 patients with confirmed diagnosis of cryptococcemia in the First Affiliated Hospital of Zhejiang University School of Medicine between December 2002 and March 2014. According to patients’ immune status,they were divided into two groups：immunocompromised group（ 41 cases） and immunocompetent group（ 9 cases）. The patients’ gender,age,clinical manifestation,laboratory examination,antifungal drugs and curative effect were analyzed. Results A total of50 patients were selected,with 30 males and 20 females,and the average age was 49 ± 17. 0 years old（ ranged from 15 to 83 years）. 43 patients had different degrees of fever. There was no difference between the two groups in gender,age,average hospitalization time,clinical manifestation,white blood cells,neutrophils ratio,C-reactive protein and urea nitrogen. The rate of cryptococcal meningitis complication in immunocompromised group was higher than that in immunocompetent group. Ten patients died during hospital stay,13 patients’ condition deteriorated,while 27 patients got better. Conclusion The clinical manifestations of cryptococcemia is not typical. Cryptococcemia is more likely to occur in immunocompromised group than in immunocompetent group. Immunocompromised group are more likely to complicate with cryptococcal meningitis and pulmonary cryptococcosis. The prognosis of cryptococcemia is poor.