本文選題：隱球菌病 + 肺　； 參考：《中國(guó)全科醫(yī)學(xué)》2017年15期

【摘要】：目的探討免疫抑制和非免疫抑制患者肺隱球菌病(PC)的臨床特征,以期提高臨床醫(yī)師對(duì)本病的診治水平。方法回顧性選取2008年1月—2015年12月于金華市人民醫(yī)院住院的PC患者84例為研究對(duì)象。將患有AIDS、器官移植術(shù)后、長(zhǎng)期使用糖皮質(zhì)激素及免疫抑制藥物的患者納入免疫抑制組(43例),無(wú)以上疾病和未接受上述治療的患者納入非免疫抑制組(41例)。收集并比較兩組患者一般資料、臨床表現(xiàn)、輔助檢查結(jié)果。結(jié)果免疫抑制組入院至確診時(shí)間短于非免疫抑制組,住院時(shí)間長(zhǎng)于非免疫抑制組,死亡率高于非免疫抑制組(P0.05)。免疫抑制組頭痛、惡心嘔吐、合并隱球菌腦膜炎發(fā)生率高于非免疫抑制組(P0.05)。免疫抑制組白細(xì)胞計(jì)數(shù)、血清清蛋白水平、血隱球菌莢膜多糖抗原陽(yáng)性率、CD_3~+T淋巴細(xì)胞水平、CD_4~+T淋巴細(xì)胞水平低于非免疫抑制組(P0.05);免疫抑制組單發(fā)結(jié)節(jié)/腫塊型病灶發(fā)生率低于非免疫抑制組,多發(fā)結(jié)節(jié)/腫塊型病灶發(fā)生率高于非免疫抑制組(P0.05);免疫抑制組空洞征發(fā)生率高于非免疫抑制組,單側(cè)肺受累發(fā)生率低于非免疫抑制組(P0.05)。結(jié)論免疫抑制患者PC更易合并中樞神經(jīng)系統(tǒng)隱球菌感染,多以頭痛、惡心嘔吐為首診原因,病死率較高,隱球菌莢膜多糖抗原陽(yáng)性率較低,以多發(fā)結(jié)節(jié)/腫塊型病灶、雙側(cè)肺受累為主,空洞征發(fā)生率較高;而非免疫抑制患者PC以單發(fā)結(jié)節(jié)/腫塊型病灶、單側(cè)肺受累為主。
[Abstract]:Objective to investigate the clinical features of pulmonary cryptococcosis (PCS) in immunosuppressive and non-immunosuppressive patients in order to improve the diagnosis and treatment of the disease. Methods 84 PC patients hospitalized in Jinhua people's Hospital from January 2008 to December 2015 were retrospectively selected. Patients with AIDS, organ transplantation, long-term use of glucocorticoid and immunosuppressive drugs were included in the immunosuppression group (n = 43), and patients without above disease and without above treatment were included in the non-immunosuppressive group (n = 41). To collect and compare the general data, clinical manifestations and auxiliary examination results of the two groups. Results the time from admission to diagnosis in immunosuppression group was shorter than that in non-immunosuppressive group, and the hospitalization time was longer than that in non-immunosuppressive group, and the mortality was higher than that in non-immunosuppressive group (P 0.05). The incidence of headache, nausea and vomiting and cryptococcal meningitis in immunosuppressive group was higher than that in non-immunosuppressive group (P 0.05). In immunosuppressive group, white blood cell count, serum albumin level, The positive rate of Cryptococcus perfringens polysaccharide antigen and the level of CD3 ~ T lymphocyte were lower than that of non-immunosuppressive group (P 0.05), and the incidence of single nodule / mass lesion in immunosuppressive group was lower than that in non-immunosuppressive group. The incidence of multiple nodule / mass lesion was higher than that of non-immunosuppressive group (P 0.05), the incidence of cavitation sign in immunosuppressive group was higher than that in non-immunosuppressive group, and the incidence of unilateral lung involvement was lower than that of non-immunosuppressive group (P 0.05). Conclusion PC in immunosuppressive patients is more likely to be associated with cryptococcal infection in the central nervous system, with headache, nausea and vomiting as the first reason, higher mortality, lower positive rate of Cryptococcus perfringens polysaccharide antigen, and multiple nodule / mass lesions. The incidence of cavitation sign was higher in both sides of lung than that in non-immunosuppressive patients with single nodule / mass lesion and unilateral lung involvement.
【作者單位】： 浙江省金華市人民醫(yī)院呼吸內(nèi)科;
【分類號(hào)】：R519.4

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