CAJ | 학술논문

目的探讨肺隐球菌病的临床特点、影像学表现、病理特征、治疗方法及预后。方法收集南京军区福州总医院2003年3月至2010年2月经病理确诊的38例肺隐球菌病患者的临床资料，并对相关资料进行分析。结果 38例均为社区获得性肺炎，其中男29例，女9例，年龄21～70岁，平均(47±13)岁。38例中伴基础疾病者9例。流式细胞分析CD4细胞正常20例。影像学表现：35例病变靠近胸膜，以下肺部受累多见，其中左下肺21例，右下肺23例；单发结节影11例，多发结节影16例，多发斑片状影3例，肿块伴多发结节5例，弥漫性肺实质浸润影3例；4例患者行18F-脱氧葡萄糖正电子发射计算机断层显像(PET-CT)检查，病灶均有较高的标准化摄取值（SUV值）。经皮肺穿刺活检确诊33例，开胸手术确诊1例，胸腔镜手术确诊3例，淋巴结活检确诊1例。治愈34例，显效3例，死亡1例。结论在门诊就诊的肺部阴影患者中，肺隐球菌病应作为诊断及鉴别诊断的疾病之一。肺隐球菌病的影像学表现具有病灶多发、靠近胸膜及多位于下肺部等特点，但临床表现无特异性。经皮肺穿刺活检是确诊的有效方法之一。
목적 탐토폐은구균병적림상특점、영상학표현、병리특정、치료방법급예후。방법수집남경군구복주총의원2003년3월지2010년2월경병리학진적38례폐은구균병환자적림상자료，병대상관자료진행분석。결과 38례균위사구획득성폐염，기중남29례，녀9례，년령21～70세，평균(47±13)세。38례중반기출질병자9례。류식세포분석CD4세포정상20례。영상학표현：35례병변고근흉막，이하폐부수루다견，기중좌하폐21례，우하폐23례；단발결절영11례，다발결절영16례，다발반편상영3례，종괴반다발결절5례，미만성폐실질침윤영3례；4례환자행18F-탈양포도당정전자발사계산궤단층현상(PET-CT)검사，병조균유교고적표준화섭취치（SUV치）。경피폐천자활검학진33례，개흉수술학진1례，흉강경수술학진3례，림파결활검학진1례。치유34례，현효3례，사망1례。결론 재문진취진적폐부음영환자중，폐은구균병응작위진단급감별진단적질병지일。폐은구균병적영상학표현구유병조다발、고근흉막급다위우하폐부등특점，단림상표현무특이성。경피폐천자활검시학진적유효방법지일。
Objective To investigate the clinical features, radiology, diagnosis and treatment of pulmonary cryptococcosis.MethodsA total of 38 cases of pulmonary cryptococcosis, confirmed by pathological examinations at Fuzhou General Clinical Medical College, Fujian Medical University from March 2003 to February 2010, were retrospectively studied.Results All of the cases were community-acquired.The patients consisted of 29 males and 9 females, aged from 21 to 70 years.There were no underlying diseases in 29 cases.The CD4 cell numbers were normal in 20 patients.Radiological study showed that the majority of the lesions (35 cases) were close to the pleura.Lower lungs were often involved (left 21 and right 23).Pulmonary nodules, either solitary nodules (11 cases) or multiple nodules (16 cases), were the most common CT finding.The lesions had a higher standardized uptake value (SUV) in 4 patients with a PET-CT scan.The lung specimens of 33 cases were obtained by CT guided transthoracic needle aspiration biopsy.The disease was cured in 34 cases , and improved in 3 cases, but 1 died.Conclusions Pulmonary cryptococcosis must be considered in the differential diagnosis of lesions of the lungs.The disease has some characteristics on radiology, such as multiple lesions, always close to the pleura and occurs frequently in the lower lungs.CT guided percutaneous biopsy is a safe and effective method for diagnosis.