【摘要】：目的探討肺隱球菌病的臨床特點(diǎn)及胸部CT特征性表現(xiàn),提高醫(yī)師對(duì)肺隱球菌病的認(rèn)識(shí)水平及早期確診率。方法回顧我院呼吸內(nèi)科自2011年-2016年確診的2例肺隱球菌病患者的病例資料,并結(jié)合中國(guó)知網(wǎng)網(wǎng)絡(luò)出版總庫(kù)近10年內(nèi)收錄的國(guó)內(nèi)肺隱球菌病相關(guān)文獻(xiàn)資料經(jīng)篩選后的432例肺隱球菌病共同進(jìn)行綜合分析,總結(jié)肺隱球菌病的發(fā)病人群、易感因素、臨床表現(xiàn)、胸部CT影像學(xué)特點(diǎn)、診斷手段、誤診類(lèi)型及誤診原因。結(jié)果(1)入選文獻(xiàn)98篇,結(jié)合我科確診的2例臨床資料,共計(jì)肺隱球菌病患者434例,男女比例為1.95:1,80.6%(204/253)的肺隱球菌病患者無(wú)明確的鳥(niǎo)類(lèi)、家禽及土壤等接觸史,65.8%(244/371)患者否認(rèn)基礎(chǔ)疾病史,26.0%(113/434)患者無(wú)任何自覺(jué)癥狀,余以咳嗽咳痰、胸痛、發(fā)熱等非特異性癥狀就診。(2)胸部CT表現(xiàn)中結(jié)節(jié)影或團(tuán)塊影占73.7%,斑片狀浸潤(rùn)影或?qū)嵶冇罢?5.0%,混合型病變占10.1%,彌漫粟粒影5例,占1.2%。(3)常見(jiàn)誤診疾病依次為肺癌或肺部轉(zhuǎn)移瘤147例(49.4%),普通細(xì)菌性肺炎68(23.0%)例,肺結(jié)核55例(18.6%)。(4)97.9%的患者(426/434)通過(guò)經(jīng)皮肺穿刺、開(kāi)胸手術(shù)、支氣管鏡活檢、胸腔鏡肺葉切除或活檢標(biāo)本的病理組織學(xué)確診,少數(shù)為呼吸道分泌物或血液、腦脊液等體液標(biāo)本病原學(xué)確診。結(jié)論1、近10年的文獻(xiàn)回顧分析發(fā)現(xiàn),PC在免疫功能“正�！钡幕颊咧胁⒉簧僖�(jiàn),尤其中青年男性,多數(shù)患者無(wú)明確接觸史。2、PC分布存在地區(qū)差異,在國(guó)內(nèi)南方發(fā)病多于北方。3、PC患者的臨床表現(xiàn)缺乏特異性,胸部病變以肺外帶、肺下葉多見(jiàn),病灶形態(tài)各異,結(jié)節(jié)性腫塊在免疫功能正�；颊咧休^為常見(jiàn)。4、經(jīng)皮肺穿刺活檢術(shù)在肺隱球菌病診斷中占有重要地位,隱球菌乳膠凝集試驗(yàn)具有較高的特異性及靈敏性,可作為PC的早期篩查檢查及療效評(píng)估指標(biāo)。
[Abstract]:Objective to investigate the clinical features and chest CT features of pulmonary cryptococcosis and to improve the understanding level and early diagnosis rate of pulmonary cryptococcosis. Methods the data of 2 cases of pulmonary cryptococcosis diagnosed in Department of Respiratory Medicine from 2011 to 2016 were retrospectively reviewed. Combined with 432 cases of pulmonary Cryptococcosis collected in China's General Library of Web Publishing in recent 10 years after screening, the incidence population, susceptible factors and clinical manifestations of pulmonary Cryptococcus pneumoniae were summarized, and a comprehensive analysis was carried out on 432 cases of pulmonary Cryptococcus pneumoniae after screening, and summarized the incidence population, susceptible factors and clinical manifestations of pulmonary Cryptococcus pneumoniae. Chest CT imaging features, diagnostic methods, types of misdiagnosis and causes of misdiagnosis. Results (1) A total of 434 patients with pulmonary Cryptococcus pneumoniae were included in 98 articles of literature and 2 cases confirmed in our department. There were no definite birds in lung Cryptococcus pneumoniae patients whose male and female ratio was 1.95: 1% (204 / 253). 65.8% (244 / 371) of patients with history of contact with poultry and soil denied that 26.0% (113 / 434) of patients with underlying diseases had no conscious symptoms and had cough, sputum and chest pain. Fever and other nonspecific symptoms. (2) in chest CT, nodular shadow or mass shadow accounted for 73.7%, macular infiltrating shadow or solid shadow accounted for 15.0%, mixed lesion accounted for 10.1%, diffuse miliary shadow in 5 cases. (3) the most common misdiagnosed diseases were lung cancer or pulmonary metastases (49.4%), common bacterial pneumonia (68 cases) (23.0%), pulmonary tuberculosis (55 cases (18.6%). (4) 97.9% (42.6%) patients (42.6% 434) by percutaneous lung puncture, thoracotomy, bronchoscopy biopsy. The histopathological diagnosis of thoracoscopic lobectomy or biopsy was confirmed, and a few samples of respiratory tract secretion, blood and cerebrospinal fluid were confirmed by etiology. Conclusion 1. The retrospective analysis of the literature in the past 10 years showed that the distribution of PC was not uncommon in the patients with normal immune function, especially in young and middle-aged men, and most of the patients had no definite contact history and the distribution of PC was different in different regions. The clinical manifestations of the patients with PC in the south of China are more than those in the north. The chest lesions are extrapulmonary, the lower lobes of the lungs are more common, and the lesions are different in shape. Nodular mass is more common in patients with normal immune function. Percutaneous pulmonary biopsy plays an important role in the diagnosis of pulmonary cryptococcosis. The latex agglutination test of Cryptococcus has high specificity and sensitivity. It can be used as an index of early screening and curative effect evaluation of PC.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R519.4

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