肺及肺外隐球菌病的临床特征及预后因素。

Clinical characteristics and prognostic factors of pulmonary and extrapulmonary cryptococcosis.

机构信息

Department of Infectious Disease, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230000, China.

Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.

出版信息

BMC Infect Dis. 2024 Sep 20;24(1):1018. doi: 10.1186/s12879-024-09895-9.

DOI:10.1186/s12879-024-09895-9

PMID:39304813

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11414175/

Abstract

BACKGROUND

Cryptococcosis is progressively acknowledged among people, irrespective of the human with or without immunodeficiency virus (HIV). This change in epidemiology has been recorded in recent years, prompting closer examination and a broader understanding of the disease manifestations and risk factors.

METHODS

The data of cryptococcal infections in China during 11 years were retrospectively analyzed. According to the position of infection, the patients were categorized into the pulmonary infection group and extrapulmonary infection group. The composition of the two groups was compared, and the potential risk factors of disseminated infection were analyzed. Logistic regression was used to analyze the prognostic risk factors of the disease.

RESULTS

A total of 165 patients were enrolled. 113 (68.5%) were male, and the age was 47.49 (18-82) years. 101 cases (61.2%) had a normal immune function and 64 cases (38.8%) had impaired immune function. 45 patients had extrapulmonary infection, involving the central nervous system, bone and joint, skin and bloodstream, and 120 patients had simple pulmonary infection. The mortality of the extrapulmonary infection group (48.9%) was significantly higher than that of the pulmonary infection group (0.8%). According to univariate logistic regression analysis, immune status (hazard ratio [HR], 4.476; 95% confidence interval [CI], 1.725-11.618; P = 0.002), infection position ([HR], 113.826; [CI], 14.607-886.967; P < 0.001), white blood cell count, ([HR],1.209;[CI], 1.054-1.386; P = 0.007), hemoglobin ([HR], 0.970; [CI], 0.955-0.986; P < 0.001), platelet count ([HR], 0.993; [CI], 0.987-0.999; P = 0.026), neutrophil percentage ([HR], 1.115; [CI], 1.065-1.168; P < 0.001), lymphocyte percentage ([HR], 0.875; [CI], 0.827-0.927; P < 0.001), neutrophil-to-lymphocyte Ratio (NLR) ([HR], 1.144; [CI], 1.072-1.221; P < 0.001), monocyte percentage ([HR], 0.752; [CI], 0.618-0.915; P = 0.004) were related to the prognosis. Multivariate logistic regression analysis showed that the infection position was remained related to the prognosis with statistical significance ([HR], 0.018; [CI], 0.001-0.384; P = 0.001).

CONCLUSION

Extrapulmonary infection of Cryptococcosis is an important risk factor for prognosis. High levels of neutrophils and NLR, and low levels of lymphocytes and monocytes may lead to disseminated infection of Cryptococcosis. Further studies are needed to reduce the occurrence rate of extrapulmonary infection and mortality.

摘要

背景

cryptococcosis 在人群中逐渐被认识到，无论患者是否患有免疫缺陷病毒（HIV）。近年来，这种流行病学的变化已经被记录下来，促使人们更密切地检查和更广泛地了解疾病的表现和危险因素。

方法

回顾性分析了 11 年来中国 cryptococcal 感染患者的数据。根据感染部位，将患者分为肺部感染组和肺外感染组。比较两组的构成，并分析弥散性感染的潜在危险因素。采用 logistic 回归分析疾病的预后危险因素。

结果

共纳入 165 例患者。其中 113 例（68.5%）为男性，年龄 47.49（18-82）岁。101 例（61.2%）具有正常免疫功能，64 例（38.8%）具有免疫功能受损。45 例为肺外感染，涉及中枢神经系统、骨和关节、皮肤和血流，120 例为单纯肺部感染。肺外感染组（48.9%）的死亡率明显高于肺部感染组（0.8%）。单因素 logistic 回归分析显示，免疫状态（风险比[HR]，4.476；95%置信区间[CI]，1.725-11.618；P=0.002）、感染部位（[HR]，113.826；[CI]，14.607-886.967；P<0.001）、白细胞计数、（[HR]，1.209；[CI]，1.054-1.386；P=0.007）、血红蛋白（[HR]，0.970；[CI]，0.955-0.986；P<0.001）、血小板计数（[HR]，0.993；[CI]，0.987-0.999；P=0.026）、中性粒细胞百分比（[HR]，1.115；[CI]，1.065-1.168；P<0.001）、淋巴细胞百分比（[HR]，0.875；[CI]，0.827-0.927；P<0.001）、中性粒细胞与淋巴细胞比值（NLR）（[HR]，1.144；[CI]，1.072-1.221；P<0.001）、单核细胞百分比（[HR]，0.752；[CI]，0.618-0.915；P=0.004）与预后相关。多因素 logistic 回归分析显示，感染部位与预后仍有统计学意义（[HR]，0.018；[CI]，0.001-0.384；P=0.001）。