本文選題：肺隱球菌病 + 流行病學(xué)��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:搜集1999年至2016年年間天津市多家醫(yī)院收治的確診肺隱球菌病的75名患者進(jìn)行統(tǒng)計學(xué)對比,以分析宿主因素的不同對隱球菌感染患者臨床特點(diǎn)的影響。研究內(nèi)容與方法:將75例肺隱球菌病患者分成有基礎(chǔ)疾病組和無基礎(chǔ)疾病組,對比分析兩組患者的性別、年齡分布,既往有無鴿子接觸史,臨床表現(xiàn),實(shí)驗室化驗指標(biāo)、乳膠凝集試驗結(jié)果、胸部影像學(xué)表現(xiàn)等。研究結(jié)果:自1999年至2016年肺隱球菌病患者呈逐年上升趨勢。無基礎(chǔ)疾病組和有基礎(chǔ)疾病組分別占43例、32例,其中男女各占42、33例,兩組患者無性別分布差異(P=0.579)。年齡均在23-76歲之間,平均年齡48.72±10.23,兩組患者好發(fā)年齡段均在41-50歲之間,其中有基礎(chǔ)疾病者平均年齡51.06±10.22,無基礎(chǔ)疾病者平均年齡46.98±10.00,兩組發(fā)病年齡無統(tǒng)計學(xué)差異(P=0.887)。有鴿子接觸史的占25例(33.3%),兩組患者無統(tǒng)計學(xué)差異。該病常見的臨床表現(xiàn)有咳嗽、發(fā)熱、咳痰、胸悶、胸痛,少見有氣短、咯血,無癥狀患者兩組無統(tǒng)計學(xué)差異(P=0.133),有基礎(chǔ)疾病者出現(xiàn)發(fā)熱的更多見(P=0.010),無基礎(chǔ)疾病者出現(xiàn)咳嗽的更多見(P=0.043)。白細(xì)胞計數(shù)、中性粒細(xì)胞比值、血沉、降鈣素原等在無基礎(chǔ)疾病和有基礎(chǔ)疾病兩組患者并無統(tǒng)計學(xué)差異(P值分別為0.28,0.065,0.274,0.073),C反應(yīng)蛋白在兩組患者中的差異有統(tǒng)計學(xué)意義(P=0.019)。56例患者接受隱球菌血清莢膜多糖乳膠凝集試驗的檢測,陽性者51例(91.1%),陰性者5例(8.9%),兩組患者在血清莢膜多糖乳膠凝集試驗檢測上無差異(P=0.062)。累及兩側(cè)肺的有30例(40.0%),累及單側(cè)肺的占45例(60.0%),兩組患者具有統(tǒng)計學(xué)差異(P=0.012);病灶單發(fā)者25例(33.3%),多發(fā)者50例(66.7%),兩組患者無統(tǒng)計學(xué)差異(P=0.141);累及胸膜下的患者有38例(50.7%),無基礎(chǔ)疾病者更易累及胸膜下,二組患者具有統(tǒng)計學(xué)意義(P=0.041)。結(jié)節(jié)腫塊型26例(34.7%),是75例患者中出現(xiàn)最多的影像學(xué)表現(xiàn),也是無基礎(chǔ)疾病患者中出現(xiàn)最多的,二者具有統(tǒng)計學(xué)差異(P=0.011),單純發(fā)生浸潤型改變的有25例(33.3%),混合型22例(29.3%),是有基礎(chǔ)疾病患者中出現(xiàn)最多的影像學(xué)表現(xiàn),兩組患者表現(xiàn)出統(tǒng)計學(xué)差異(P=0.018)。胸腔積液、暈征、牽拉支氣管擴(kuò)張、含氣支氣管征、空洞等影像學(xué)伴隨征象于兩組患者之間無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:肺隱球菌病患病率呈逐年上升的趨勢,好發(fā)于中青年男性,一部分患者具有鴿子接觸史,但不能單純憑借接觸史排除或確定隱球菌感染的可能性;無基礎(chǔ)疾病者患病率逐漸高于有基礎(chǔ)疾病者,除結(jié)核、乙肝、HIV外,合并支氣管哮喘、慢性阻塞性肺病等原發(fā)基礎(chǔ)肺部疾病者更應(yīng)注意有無隱球菌感染的可能;肺隱球菌病的臨床表現(xiàn)非特異,部分患者無癥狀,而發(fā)熱、咳嗽分別于有基礎(chǔ)疾病者和無基礎(chǔ)疾病者更易出現(xiàn);隱球菌血清乳膠凝集試驗對于評估隱球菌感染具有較高的特異性和敏感性;無基礎(chǔ)疾病者多見胸膜下、合并暈征、含氣支氣管征的結(jié)節(jié)腫塊型的影像學(xué)表現(xiàn),合并基礎(chǔ)疾病者多見混合型病變及間質(zhì)性病變。
[Abstract]:Objective: to collect and compare 75 patients with confirmed pulmonary cryptococcosis in Tianjin from 1999 to 2016 to analyze the effects of different host factors on the clinical characteristics of cryptococcal infection. Research contents and methods: 75 cases of pulmonary cryptococcosis were divided into basic disease group and non basic disease. Group, compared and analyzed the sex, age distribution of the two groups, the history of dove contact, clinical manifestations, laboratory test indicators, the results of latex agglutination test and chest imaging. The results of the study: from 1999 to 2016, the patients with pulmonary cryptococcosis were increasing year by year. There were 43 cases in the non basic disease group and 32 cases with basic disease, 32 cases respectively. Among them, male and female accounted for 42,33 cases, and the two groups had no difference in sex distribution (P=0.579). The age was 23-76 years old, the average age was 48.72 + 10.23. The two groups of patients with good onset age were 41-50 years old. The average age of the patients with basic diseases was 51.06 + 10.22, the average age of those without basic diseases was 46.98 + 10, and there was no statistical difference in the age of onset of the disease in the two groups. (P=0.887) 25 cases (33.3%) with dove contact history. There was no statistical difference between the two groups. The common clinical manifestations of the disease were cough, fever, expectoration, chest tightness, chest pain, two groups of patients without symptoms of shortness of breath, hemoptysis, and asymptomatic group (P=0.133). There were more fever in patients with basic disease (P=0.010), and coughing without basic disease. More see (P=0.043). Leukocyte count, neutrophils ratio, erythrocyte sedimentation rate, calcitonin, and other two groups of patients without basic disease and basic disease (P value 0.28,0.065,0.274,0.073), C reactive protein in the two groups of patients with statistical significance (P=0.019).56 patients accepted Cryptococcus sera serum capsule The test of sugar latex agglutination test showed that 51 cases (91.1%) were positive and 5 cases (8.9%) were negative. There were no difference between the two groups in the serum capsule polysaccharide latex agglutination test (P=0.062). 30 cases (40%) involving bilateral lung, 45 cases involving unilateral lung (60%) and two groups (P=0.012), 25 cases (33.3%) in single lesion (33.3%). There were 50 cases (66.7%). There were no statistical differences in the two groups (P=0.141); 38 patients (50.7%) involved under the pleura, and those without basic diseases were more likely to be under the pleura, and the two groups were statistically significant (P=0.041). 26 cases of nodular mass (34.7%) were the most common imaging manifestations in 75 patients, and were the most common patients without basic diseases. The two had statistical difference (P=0.011), 25 cases (33.3%) and 22 cases of mixed type (29.3%) were the most important imaging manifestations in the patients with basic disease. The two groups showed statistical difference (P=0.018). Pleural effusion, halo sign, stretch bronchiectasis, gas bronchiectasis, cavity and other imaging accompanying There was no statistical difference between the two groups of patients (P0.05). Conclusion: the prevalence rate of pulmonary cryptococcosis is increasing year by year, good for young and middle-aged men, some patients have dove contact history, but can not simply rely on contact history to exclude or determine the possibility of cryptococcus infection; the prevalence rate of non basic diseases is gradually higher than that of basic diseases. In addition to tuberculosis, hepatitis B and HIV, patients with primary underlying lung diseases such as bronchial asthma and chronic obstructive pulmonary disease should be more aware of the possibility of cryptococcus infection; the clinical manifestations of pulmonary cryptococcosis are nonspecific, some patients are asymptomatic, fever, and cough of Yu Youji base disease and non basic disease are more likely to occur; Cryptococcus sera The latex agglutination test has a high specificity and sensitivity for the evaluation of cryptococcus infection. Those without basic diseases are mostly under the pleura, combined with halo sign and bronchoid nodular mass, with mixed lesions and interstitial lesions in the patients with basic diseases.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R519.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 蘭長青;黃進(jìn)寶;黃梅萍;林旭;林清華;祝偉男;王潔;;結(jié)節(jié)腫塊型肺隱球菌病CT特征分析[J];中華放射學(xué)雜志;2015年10期

2 季旭清;王海明;馬禎一;葉甫澄;;免疫正常宿主隱球菌血癥伴嗜酸粒細(xì)胞增多一例并文獻(xiàn)復(fù)習(xí)[J];中華臨床醫(yī)師雜志(電子版);2015年19期

3 王林帥;殷澤富;;肺隱球菌病的CT表現(xiàn)及其診斷價值[J];青島大學(xué)醫(yī)學(xué)院學(xué)報;2014年06期

4 李楚齊;趙振軍;張金娥;;肺隱球菌病患者免疫狀態(tài)與肺CT表現(xiàn)及病理的相關(guān)性[J];中國CT和MRI雜志;2014年03期

5 趙微;金芬華;陳良安;;解放軍總醫(yī)院20年肺隱球菌病分析[J];解放軍醫(yī)學(xué)院學(xué)報;2014年06期

6 彭雅婷;歐陽若蕓;蔣誼;;28例原發(fā)性肺隱球菌病臨床特征分析[J];中南大學(xué)學(xué)報(醫(yī)學(xué)版);2014年01期

7 張立輝;周建勤;鄺平定;;結(jié)節(jié)腫塊型肺隱球菌病的CT表現(xiàn)分析[J];醫(yī)學(xué)影像學(xué)雜志;2013年11期

8 傅美芹;王亞東;林ng欒;張立力;羅文英;趙鐵;龍敏;曹虹;;免疫抑制小鼠超聲霧化吸入新生隱球菌的實(shí)驗研究[J];南方醫(yī)科大學(xué)學(xué)報;2012年02期

9 王琴;劉莉;范碧君;李華茵;白春學(xué);宋元林;何禮賢;;55例社區(qū)獲得性肺隱球菌病病例分析[J];微生物與感染;2011年03期

10 顧煙直;黃紹萍;盧水華;;肺隱球菌病的診治進(jìn)展[J];中國全科醫(yī)學(xué);2009年18期

，

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