本文關(guān)鍵詞： 肺隱球菌病 膠體金法 新生隱球菌　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:近年來,肺隱球菌病(PC)的發(fā)病率有增加的趨勢(shì),因其臨床表現(xiàn)、肺部影像特征缺乏特異性,有創(chuàng)的病理檢查不易被接受,而病原學(xué)檢出率低,診斷較為困難,故多采用隱球菌抗原的免疫學(xué)檢查作為輔助手段。然而國內(nèi)外對(duì)隱球菌抗原的研究多集中在乳膠凝集實(shí)驗(yàn)法,很少研究膠體金法在肺隱球菌病診斷的臨床意義。目的:研究膠體金法在PC診斷的敏感性及特異性,從而評(píng)價(jià)在缺乏病理支持情況下,其對(duì)肺隱球菌病診斷的臨床意義,同時(shí)對(duì)診斷為PC患者的臨床特征進(jìn)行歸納,為臨床醫(yī)生提高對(duì)PC的認(rèn)識(shí)及早期診治提供幫助。研究對(duì)象與方法:收集吉林大學(xué)第二醫(yī)院從2014年12月1日到2016年12月31日期間懷疑PC且行膠體金法的所有住院患者的臨床資料,統(tǒng)計(jì)膠體金法診斷PC的敏感性及特異性,并對(duì)診斷為PC患者的一般資料、臨床癥狀及體征、影像學(xué)表現(xiàn)、輔助檢查、入院初步診斷及治療與預(yù)后進(jìn)行回顧性分析。結(jié)果:1.膠體金法結(jié)果:行膠體金法的患者共131例,其中陽性19例,陰性112例。陽性的19例患者中,13例為PC,6例為非PC;112例陰性患者均為非PC。膠體金法的敏感性為100%,特異性為94.92%,陽性預(yù)計(jì)值68.42%,陰性預(yù)計(jì)值100%。2.臨床特征:13例PC患者男女比例1.6:1,以50-60歲年齡段居多,均否認(rèn)隱球菌接觸史,僅1例有污水接觸史。無基礎(chǔ)疾病的占46.15%。有基礎(chǔ)疾病的占53.85%。主要表現(xiàn)為:咳嗽(69.23%)、咳痰(46.15%)、發(fā)熱(23.08%)、胸痛(15.38%)、氣短(15.38%)、咯血(15.38%)、盜汗(7.69%)、體重減輕(7.69%)、乏力(7.69%)中的一種或多種癥狀。影像學(xué)表現(xiàn)為結(jié)節(jié)/腫塊型有6例(46.14%),實(shí)變型有2例(15.38%),混合型有5例(38.47%)。病灶呈單發(fā)的有3例(23.07%),多發(fā)的有10例(76.93%)。病灶局限于單側(cè)肺的有8例(61.52%),雙側(cè)肺的有5例(38.48%)。病灶靠近肺野外周部的有11例(84.62%),中央部的有2例(15.38%)。伴隨征象有空泡征(38.46%)、毛刺(38.46%)、肺門或(和)縱膈淋巴結(jié)腫大(38.46%)、胸膜肥厚(38.46%)、暈征(23.08%)、支氣管充氣征(23.08%)、空洞(15.38%)、分葉(7.69%)、胸腔積液(7.69%)。早期誤診率高達(dá)69.23%。隨訪時(shí)間20天到18個(gè)月不等,結(jié)果為3例失訪,1例治愈,6例明顯好轉(zhuǎn),3例好轉(zhuǎn)。結(jié)論:1.本研究中膠體金法的敏感性為100%,特異性為94.92%,陽性預(yù)計(jì)值68.42%,陰性預(yù)計(jì)值100%,并且其常溫下性狀穩(wěn)定,操作簡(jiǎn)單,10分鐘即可出結(jié)果,結(jié)果判定簡(jiǎn)單,因此,膠體金法對(duì)肺隱球菌病具有較高的診斷及鑒別診斷價(jià)值,尤其可作為隱球菌感染的篩查方法,以及作為隱球菌感染的排除診斷方法。2.肺隱球菌病多見于免疫功能低下或免疫功能受損患者,但免疫功能正常的患者所占比例也相對(duì)較高,不容忽視。3.肺隱球菌病患者男性多于女性,好發(fā)于50-60年齡段,多數(shù)患者無明確鳥禽類糞便等各類接觸史。臨床表現(xiàn)缺乏特異性,以咳嗽最為常見,早期誤診率較高。肺部影像學(xué)主要表現(xiàn)為:結(jié)節(jié)/腫塊型、實(shí)變型、混合型三種。以結(jié)節(jié)/腫塊型為主,多發(fā)病變常見,多局限于單側(cè)肺,以靠近肺野外周部多見,可伴隨空泡征、毛刺、胸膜增厚等征象。4.肺隱球菌病的抗真菌治療療程較長(zhǎng),目前尚無準(zhǔn)確的抗真菌治療終點(diǎn)。
[Abstract]:Background: in recent years, pulmonary cryptococcosis (PC) the incidence rate is increasing, due to its clinical manifestations, imaging features of pulmonary pathology are lack of specificity, and is not easy to be accepted, and the pathogen detection rate is low, the diagnosis is difficult, so the cryptococcal antigen immune examination as an auxiliary means. However, the domestic and foreign research on cryptococcal antigen is more concentrated in the latex agglutination test method, colloidal gold method little research on clinical significance in the diagnosis of pulmonary cryptococcosis. Objective: To study the colloidal gold method in sensitivity and specificity of PC diagnosis, and evaluation on the lack of support for the pathological condition, clinical significance the diagnosis of pulmonary cryptococcosis, at the same time for the diagnosis of clinical characteristics of patients with PC induction for clinicians to raise awareness and help to early diagnosis and treatment of PC. Subjects and methods: the second hospital of Jilin University were collected from December 1, 2014 to 2016 During the year December 31st with suspected PC and colloidal gold method for all hospitalized patients with clinical data, sensitivity and specificity of statistical colloidal gold method for diagnosis of PC, and the diagnosis of the general information of patients with PC, clinical symptoms and signs, imaging manifestation, auxiliary examination, preliminary diagnosis and treatment and prognosis were retrospectively analyzed in hospital. Results: 1. colloidal gold method results: colloidal gold with a total of 131 cases, including 19 cases of positive and negative in 112 cases. In 19 positive patients, 13 cases were PC, 6 cases of non PC; the sensitivity of the 112 negative cases were non PC. colloidal gold method was 100%, the specificity was 94.92%, positive predictive value 68.42%, the negative predictive value of clinical features of 100%.2.: 13 cases of patients with PC male to female ratio of 1.6:1, with 50-60 years of age are denied cryptococcal contact history, only 1 cases have water contact history. No basic diseases accounted for the main performance of 53.85%. 46.15%. disease: cough 鍡，

本文編號(hào)：1456369