肺隐球菌病临床分析

:100730(),(),(),()19862001,30,7,1,18;:/=4/3,4118;(HIV),6,1,;12;,(1);(2);(3);(4),;;RetrospectiveanalysisofsevencasesofpulmonarycryptococcosisCAOBin3,ZHUYuanjue,XUWenbing,LILongyun,XIEXiuli,WANGPeng,ZHOUWeixun,CUIQuancai,LIXiaoguang,3DepartmentofRespirology,PekingUnionMedicalCollegeHospital,ChineseAcademyofMedicalSciences,Beijing100730,ChinaAbstractObjectiveTounderstandthediagnosisandtreatmentofpulmonarycryptococcosis1MethodsPatientsdiagnosedashavingpulmonarycryptococcosisinthepast15yearswereretrospecpectivelystudied1Theirdemographicdata,respiratorysymptoms,diagnosticmethods,chestradiograph,immunestate,antifungaltherapyandfollow2upresultswereanalyzed1ResultsThirtycasesofcryptococcosiswerediagnosed,ofwhich7werediagnosedashavingpulmonarycryptococcosis,oneofthempresentedwithconcomitantmeningitis1Ofthe7patients,4weremaleand3werefemale,withamedianageof41181AllwereHIVnegative;onecasewasimmunocompromisedwithahistoryofcoloncancerandglucocorticoidtherapyfor8months,whileotherswereimmunocompetent.Threepatientscomplainedoflowfeverorcoughandsputum,while4otherspresentednosymptoms1TheX2rayandchestCTshowedunilateralorbilateralpatches,nodulesorcavities1Thediagnosiswasmadebypathologyandbacterialcultureofsputumorbronchoalveolarlavagefluid1AmphotericinBplusflucytosinewereinitiallygivento4patients,allofthemdevelopedliverandrenalabnormalitiestosomedegreeaftertherapy1Threepatientsweregivenfluconazoleoritraconazoleinitially1Allthe7patientswithpulmonarycryptococcosisrespondedfavorablytoantifungaltherapyandtheprognosiswasgood1ConclusionsClinicallypulmonarycryptococcosiswaslesscommonthancryptococcalmeningitis1Pathologyandcryptococcalculturewereessentialtothediagnosis1Forimmunocompetentpatientswithpulmonarycryptococcosis,theprognosiswasgood1KeywordsCryptococcosis,pulmonary;Diagnosis;Treatment(cryptococcusneoformens),,[1],,,19862001(ICD:1171502),0162002102510ChinJTubercRespirDis,October2002,Vol25,No.10(ICD:1171503)1986200130,7(1),18,67199874,3,1863,411873(156),2(),275(HIV),;2HIV,CD4(+),HIV6,1(3)3,18(1030mg/)73,:,4,,,CT:1,,4(3,1),2,1,(5,1,2)75,(3)21,1(2),,,,7(1)7,1,,,,1986200130,7(1),18,20%(6/30)Kerkering[2],93,12(1219%),29(3112%),,52(5519%):(1),,7,3,,:;(2),,[2],,,;(3),,2080,300/;80HIV,5000/,HIV[1]HIV,,,17B(g)B(g)52FC(g/d)()(mg/d)()(mg/d)()()12.25-1.54.532005-41210201.54.5520018-333--3.04.552006-294----20051651.54.5-2001-860.92-4.522001-17---2001-11162002102510ChinJTubercRespirDis,October2002,Vol25,No.10,,,[3,4],,,2(1,5)B,1152125g352(52FC)3(63),200mg/d,6,,245,,56B,,5BB,,1B:,(Cr)80mmol/L23817mmol/L,(BUN)514mmol/L2014mmol/L;(ALT)24U/L43U/L,2(Cr124mmol/L,BUN9mmol/L,ALT47U/L),,,,,Kerkering[2]41,76,,5;34()6,2,6Aberg[5]42,18,246,(IDSA)[6](1),,,;200400mg/d,36(2),,200400mg/d,612;200400mg/d,612;,B015110mgkg-1d-1(12g):B0171mgkg-1d-1,52100mgkg-1d-1,2;400mg/d,10,,,71,62,3;6,[6],,:,;;,;,(1310-4)1SarosiGA1CryptococcallungdiseaseinpatientswithoutHIVinfection1Chest,1999,115:610261112KerkeringTM,DumaRJ,ShadomyS1Theevolutionofpulmonarycryptococcosis:clinicalimplicationsfromastudyof41patientswithandwithoutcompromisinghostfactors1AnnInternMed,1981,94:611261613,,1:1521,1991,4:251225214,,1121,2000,7:425242615AbergJA,MundyLM,PowderlyWG1PulmonarycryptococcalinpatientswithoutHIVInfection1Chest,1999,115:734274016SaagMS,GraybillRJ,LarsenRA,etal1Practiceguidelinesforthemanagementofcryptococcaldisease1ClinInfectDis,2000,30:71027181(:2001212211)(:)2162002102510ChinJTubercRespirDis,October2002,Vol25,No.10