Li Herui, Ma Yiming, Zeng Zihang, Luo Lijuan, Li Tiao, Zeng Huihui, Chen Yan
Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
Infect Drug Resist. 2022 Jul 11;15:3669-3681. doi: 10.2147/IDR.S352966. eCollection 2022.
Surgical and medical treatments are applied to pulmonary cryptococcosis (PC) in the real world, while the prognosis of different therapies is uncertain. This study investigated diagnosis, real-world therapy, follow-up outcomes, and prognosis factors, aiming to deepen our understanding of PC.
Patients pathologically diagnosed with PC were retrospectively reviewed and followed up. Further comparisons and subgroup analyses were conducted in surgical and nonsurgical treatment individuals. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with treatment failure.
One hundred and sixty-three patients were included in this study, of whom 92 underwent surgical removal of VATS or open lung surgery (68 of them received postoperative antifungal treatment) and 71 got antifungal drugs only. Compared with nonsurgical patients, surgical patients were more immunocompetent (73 [79.3%] cases vs 33 [46.5%]), showed milder symptoms and more limited pulmonary lesions. Although they had instant treatment response owing to lesions resection, there is no significant advantage in the rate of treatment failure. Multivariable regression showed independent predictive factors associated with treatment failure were polymorphonuclear (PMN)>6.30*10/L, albumin (Alb) <40g/L and antifungal dosage <400mg/d. Further analysis among patients with different immune statuses or symptoms demonstrated that sufficient antifungal dosage could reduce the rate of treatment failure.
PC showed variable and nonspecific clinical features. PC patients with limited nodules/masses and mild symptoms often led to misdiagnosis and unnecessary lung resections. The potential risk factors including higher PMN and hypoalbuminemia could help clinicians to identify PC patients with poor treatment efficiency at an early stage. To note, sufficient antifungal dosage may improve the treatment outcomes.
在现实世界中，手术和药物治疗均应用于肺隐球菌病（PC），但不同治疗方法的预后尚不确定。本研究调查了PC的诊断、实际治疗、随访结果及预后因素，旨在加深我们对PC的认识。
对经病理诊断为PC的患者进行回顾性研究及随访。对接受手术和非手术治疗的患者进行进一步比较和亚组分析。采用单因素和多因素逻辑回归方法探讨与治疗失败相关的危险因素。
本研究共纳入163例患者，其中92例行电视辅助胸腔镜手术（VATS）或开胸肺手术切除（其中68例接受术后抗真菌治疗），71例仅接受抗真菌药物治疗。与非手术患者相比，手术患者免疫功能更强（73例[79.3%] vs 33例[46.5%]），症状较轻，肺部病变范围更局限。尽管手术切除病变后患者有即刻治疗反应，但在治疗失败率方面并无显著优势。多因素回归显示，与治疗失败相关的独立预测因素为多形核白细胞（PMN）>6.30×10⁹/L、白蛋白（Alb）<40g/L及抗真菌药物剂量<400mg/d。在不同免疫状态或症状的患者中进一步分析表明，足够的抗真菌药物剂量可降低治疗失败率。
PC表现出多样且非特异性的临床特征。有局限性结节/肿块且症状较轻的PC患者常导致误诊及不必要的肺切除。包括PMN升高和低白蛋白血症在内的潜在危险因素可帮助临床医生早期识别治疗效果不佳的PC患者。需要注意的是，足够的抗真菌药物剂量可能改善治疗结果。
