不同免疫状态肺隐球菌病临床特点分析

目的总结国内不同免疫状态人群肺隐球菌病（Pulmonary cryptococcosis，PC）临床特点，以提高该病的临床诊治水平。方法回顾性分析1998～2009年上海多家教学医院的100例Pc患者临床资料。结果既往无基础疾病史者占46．00％。临床以咳嗽、咳痰、发热为主要首发症状。无症状者多见于非免疫受损患者。非免疫受损PC病灶以胸膜下分布为主（55．22％），单肺累及占72．97％，病灶位于肺野局部者占59．46％，病灶形态以结节／肿块影为主（55．41％）；而免疫受损患者病灶表现多样化，分布广泛而随机。19例患者行经支气管镜肺活检（TBLB），病理结果阳性14例（73．68％）。36例患者行经皮肺穿刺活检（PCNB），病理阳性26例（72．22％）。结论既往无基础疾病不能排除Pc可能。非免疫受损Pc患者病灶多靠近胸膜，病变较局限，形态以结节／肿块影多见。免疫受损患者病灶表现多样化，分布广泛而随机。TBLB和PCNB诊断PC阳性率较高，且两者可互为补充。

Analysis on clinical characteristics of pulmonary cryptococcosis under different immune status

Objective To improve clinical diagnosis and treatment of pulmonary cryptococcosis by analyzing clinical characteris- tics of pulmonary cryptococcosis in patients with different immunological status. Methods We retrospectively analyzed the medical records of 100 patients diagnosed with pulmonary cryptococcosis in major teaching hospitals of Shanghai between 1998 and 2009. Reo suits 46.00 % of the patients with pulmonary cryptococcosis had no other diseases previously. In clinic, the major primary symp- toms included cough, expectoration, and fever. The patients without immune dysfunction usually had no symptoms, in which the le- sions were mainly under pleurapulmonalis （66.22%）, in unilateral lung （72.97%） and single lung lobe （59.46%）, and mostly appeared as nodules or masses （55.41%）. However, the lesions in patients with immune dysfunction varied with wide and random distribution. 14 out of 19 cases （73.68%） were diagnosed by the transbronchial lung biopsy （TBLB）. 26 out of 36 cases （72. 22% ） were diagnosed by the percutancous cutting needle biopsy （PCNB）. Conclusion The patients without other diseases previ- ously cannot be excluded from pulmonary cryptococcosis. The lesions in patients without immune dysfunction are mainly under pliera- pulmonalis with limited distribution, and most of them appeare as nodules and masses. However, the lesions in patients with immune dysfunction vary with wide and random distribution. TBLB and PCNB are good methods for the diagnosis of pulmonary cryptococcosis with high positive rate, and they can also compensate each other.