病灶大小作为肺部隐球菌病抗真菌治疗的预后因素：2 年随访的胸部 CT 影像学回顾性研究。

Lesion size as a prognostic factor in the antifungal treatment of pulmonary cryptococcosis: a retrospective study with chest CT pictorial review of 2-year follow up.

机构信息

Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

Department of Pulmonary Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, 361015, China.

出版信息

BMC Infect Dis. 2023 Mar 14;23(1):153. doi: 10.1186/s12879-023-08131-0.

DOI:10.1186/s12879-023-08131-0

PMID:36918805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10012437/

Abstract

BACKGROUND

Pulmonary cryptococcosis (PC) is a fungal infection that can have a variable prognosis depending on several factors. The objective of this study was to analyse the characteristics of pulmonary lesions and identify prognostic factors in patients with PC who were human immunodeficiency virus (HIV) -negative and underwent antifungal treatment.

METHODS

The study enrolled patients diagnosed with PC who were negative for HIV. Symptoms, CT characteristics of pulmonary lesions, serum cryptococcal capsular antigen (CrAg) titre, underlying diseases, and duration of antifungal treatment were evaluated over a 2-year follow-up.

RESULTS

A total of 63 patients (40 men and 23 women) with a mean age of 50.4 years were included. Half of the patients (50.8%) were asymptomatic, and the most common symptoms were cough (44.4%), expectoration (27.0%), and fever (17.5%). Pulmonary lesions were mainly present in the peripheral and lower lobes of the lung, with 35 cases classified as nodular-type lesions and 28 cases classified as mass-type lesions. At the first, third, sixth, 12th, and 24th-month follow-ups, the median proportion of residual pulmonary lesions were 59.6%, 29.9%, 12.2%, 9.6%, and 0.0%, respectively. During antifungal treatment, the lesions of 33 patients achieved complete response, while the remaining 30 patients did not. Compared with the non-CR group, the CR group had a lower baseline serum CrAg titre (median, 1:20 vs 1:80, P < 0.01), smaller pulmonary lesion size (median area, 1.6 cm vs 6.3 cm, P < 0.01), lower Hounsfield-units (HU) radiodensity (median, - 60.0 HU vs - 28.5 HU, P < 0.05), more nodular-type lesions (72.7% vs 36.7%, P < 0.01), and fewer air-bronchogram signs (18.2% vs 43.3%, P < 0.05). Multivariate logistic regression analysis showed that a larger lesion size on chest CT scans was associated with a lower likelihood of achieving complete response [OR: 0.89; 95% CI (0.81-0.97); P < 0.05].

CONCLUSIONS

PC was more commonly observed in HIV-negative men, and chest CT scans mostly revealed nodular-type lesions. After antifungal treatment, patients with smaller lesions had a better prognosis.

摘要

背景

肺隐球菌病（PC）是一种真菌感染，其预后因多种因素而异。本研究旨在分析 HIV 阴性患者的肺部病变特征，并确定其预后因素。

方法

本研究纳入了经诊断为 PC 且 HIV 阴性的患者。在 2 年的随访过程中，对患者的症状、肺部病变 CT 特征、血清隐球菌荚膜多糖抗原（CrAg）滴度、基础疾病和抗真菌治疗时间进行评估。

结果

共纳入 63 例患者（40 例男性，23 例女性），平均年龄为 50.4 岁。半数患者（50.8%）无症状，最常见的症状为咳嗽（44.4%）、咳痰（27.0%）和发热（17.5%）。肺部病变主要位于外周和下叶，35 例为结节型病变，28 例为肿块型病变。第 1、3、6、12 和 24 个月随访时，肺部病变的中位数残留比例分别为 59.6%、29.9%、12.2%、9.6%和 0.0%。在抗真菌治疗期间，33 例患者的病变完全缓解，而其余 30 例患者未缓解。与非完全缓解（CR）组相比，CR 组的血清 CrAg 滴度基线更低（中位数：1：20 比 1：80，P<0.01），肺部病变更小（中位数面积：1.6 cm 比 6.3 cm，P<0.01），CT 密度更低（中位数 CT 值：-60.0 HU 比-28.5 HU，P<0.05），结节型病变更多（72.7%比 36.7%，P<0.01），空气支气管征更少（18.2%比 43.3%，P<0.05）。多变量逻辑回归分析显示，胸部 CT 扫描上的病变越大，完全缓解的可能性越低[比值比：0.89；95%可信区间（0.81-0.97）；P<0.05]。