Zhang Ping-hai, Hu Bi-jie, He Li-xian, Li Hua-yin, Wang Bao-qing, Chen Xue-hua, Pan Jue, Jiang Hong-ni, Zhou Chun-mei, Gao Xiao-dong, Xie Hong-mei, Huang Sheng-lei, Xia Wen-song, Tao Li-li, Bai Chun-xue
Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Nei Ke Za Zhi. 2009 May;48(5):362-6.
To further elucidate the CT characteristics and diagnostic approaches to non-acquired immune deficiency syndrome patients with pulmonary cryptococcosis.
The histories of forty-two pulmonary cryptococcosis (PC) patients diagnosed in Zhongshan Hospital from 2003-2008 were collected and analyzed for demography data, underlying conditions, clinical symptoms, chest CT and diagnostic studies.
None of the 42 PC patients had avian or its feces contacting history, and 71.4% (30/42) of them were immunocompetent. The most frequent CT lesions were multiple nodules (67.9%) with peripheral predominance (67.9%), and cavitations (50%) often presented within them. Masses/consolidation (31.4%) and patching lesions (2.9%) could exist occasionally. Positive detection rates of non-aggressive examinations including sputum, bronchoalveolar lavage fluid and bronchofibroscopy aspiration were 4.3%, 8.3% and 6.3% respectively, while those of aggressive approaches including transbronchial lung biopsy (TBLB), thin needle aspiration biopsy (TNAB) and pneumonectomy by surgery were 64.7%, 64.3% and 100% respectively. Non-aggressive serum cryptococcus antigen test was performed in 14 patients who had been diagnosed by histopathology or pathogen culture, and all of them were positive.
Our study suggests that PC is common in immunocompetent population. Avian or its feces contacting is not so important as used opinion to PC differential diagnosis. CT characteristics of PC are diversiform and always change very slowly. Besides the most frequent multiple nodules with subpleural predominance, pulmonary lesions can present as masses, consolidation or patching. Aggressive techniques such as TBLB and TNAB are benefit to clinical diagnosis of PC, and non-aggressive serum cryptococcus antigen test may be promising for its early diagnosis as well as clinical course follow-up and therapeutic effect evaluation.
进一步阐明非获得性免疫缺陷综合征肺隐球菌病患者的CT特征及诊断方法。
收集2003年至2008年在中山医院确诊的42例肺隐球菌病（PC）患者的病史，分析其人口统计学数据、基础疾病、临床症状、胸部CT及诊断检查情况。
42例PC患者均无禽类或其粪便接触史，其中71.4%（30/42）免疫功能正常。最常见的CT表现为多发结节（67.9%），以外周为主（67.9%），且常伴有空洞（50%）。偶可见肿块/实变（31.4%）及斑片状病变（2.9%）。痰液、支气管肺泡灌洗液及纤维支气管镜吸取物等非侵袭性检查的阳性检出率分别为4.3%、8.3%和6.3%，而经支气管肺活检（TBLB）、细针穿刺活检（TNAB）及手术肺切除等侵袭性检查的阳性检出率分别为64.7%、64.3%和100%。对14例经组织病理学或病原体培养确诊的患者进行了非侵袭性血清隐球菌抗原检测，结果均为阳性。
本研究提示PC在免疫功能正常人群中较为常见。禽类或其粪便接触史在PC鉴别诊断中并不像以往认为的那么重要。PC的CT表现多样且变化缓慢。除最常见的以胸膜下为主的多发结节外，肺部病变还可表现为肿块、实变或斑片状。TBLB和TNAB等侵袭性技术有助于PC的临床诊断，非侵袭性血清隐球菌抗原检测对其早期诊断、临床病程随访及治疗效果评估也可能具有重要价值。
