肺隱球菌病的臨床表現(xiàn)與患者基礎(chǔ)免疫狀態(tài)的關(guān)系
【摘要】肺隱球菌病主要發(fā)生于免疫抑制患者，有時(shí)也見(jiàn)于免疫正常者。臨床癥狀缺乏特異性，以咳嗽最多見(jiàn)，其次為咳痰、發(fā)熱、胸痛和呼吸困難。影像學(xué)表現(xiàn)多樣，通常分為結(jié)節(jié)/團(tuán)塊影、片狀浸潤(rùn)影和彌漫混合病變?nèi)N類型。免疫功能正常的患者臨床癥狀輕，且相當(dāng)一部分患者無(wú)癥狀，影像學(xué)表現(xiàn)多為結(jié)節(jié)影，感染部位局限，多不發(fā)生播散，預(yù)后好。HIV陰性免疫抑制患者往往多種癥狀同時(shí)存在，病情較重，影像學(xué)表現(xiàn)約三分之二的患者可見(jiàn)肺部結(jié)節(jié)內(nèi)空洞，且彌漫混合病變?cè)龆啵s50%的患者累及中樞神經(jīng)系統(tǒng)。HIV感染患者罹患肺隱球菌病時(shí)病情重，常出現(xiàn)高熱、呼吸困難、呼吸衰竭，多累及中樞神經(jīng)系統(tǒng)，且往往為首發(fā)表現(xiàn)，預(yù)后差。
【關(guān)鍵詞】肺隱球菌病; 免疫抑制患者; 人類免疫缺陷病毒
Pulmonary Cryptococcosis: Correlation Between Clinical Manifestations And Immune Status,Zhou Qing-Tao,He Bei,Peking University The Third Hospital,Beijing,100010,China
【Abstract】 Pulmonary cryptococcosis (PC) typically occurs in immunocompromised patients,but it can also occur in immunocompetent persons.Symptoms of PC are non-specific,cough is the most common symptom,followed by expectoration,fever,chest pain and dyspnea, and some patients may be asymptomatic.There are three types of radiologic abnormalities on chest computed tomography scans,including solitary or multiple pulmonary nodules/masses,patchy infiltration,and diffusing mixed lesions.The clinical manifestation of PC partly depends on immune status of patients.
【Key words】 Pulmonary cryptococcosis;Immunocompromised patient;Human immunodeficiency virus