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目的提高肺隐球菌病早期诊断与治疗的水平。方法对浙江大学医院附属第一医院2006年9月至2009年9月收治的35例病理确诊为肺隐球菌病患者的性别、年龄分布、职业情况、基础疾病、诱因、临床表现、实验室检查、影像学特征、治疗方案及预后特点等进行回顾性分析。结果患者以中青年男性为主,多数患者有基础疾病或诱因,临床症状相对轻微,其中40%无症状,一般实验室检查,气管镜检查及病原学检查阳性率极低,影像学表现以单发或多发结节肿块影为主(共占65.7%),氟康唑治疗3～9个月一般均能治愈,但亦有17.6%迁延不愈或无效者。结论中青年患者,无发热性肺部感染性病变,症状轻微,血象正常,血沉正常,痰细菌学检查阴性,考虑肺隐球菌病可能,尽早取得组织病理学依据,治疗首选氟康唑,疗程3～9个月,手术病理明确并病灶切除者,术后仍需常规应用氟康唑治疗。
Objective To improve the early diagnosis and treatment of pulmonary cryptococcosis. Methods The gender, age distribution, occupational status, underlying diseases, causes, clinical manifestations, laboratory tests of 35 patients with pathologically confirmed pulmonary cryptococcosis admitted to the First Affiliated Hospital of Zhejiang University Hospital from September 2006 to September 2009 were retrospectively analyzed. , Imaging features, treatment options and prognostic features were retrospectively analyzed. Results The patients were predominantly young and middle-aged men. Most patients had underlying diseases or causes. The clinical symptoms were relatively mild with asymptomatic 40% of cases. The positive rates of laboratory tests, bronchoscopy and etiological examination were very low. The imaging findings were single Hair or multiple nodules mass (65.7%), fluconazole 3 to 9 months are generally cured, but there are also 17.6% delayed healing or ineffective. Conclusions In young and middle-aged patients, no febrile pulmonary infectious lesions, mild symptoms, normal blood clots, normal erythrocyte sedimentation rate, negative sputum bacteriological examination, possible pulmonary cryptococcosis, early histopathological evidence, preferred fluconazole treatment, 3 to 9 months, clear surgical pathology and removal of the lesion, postoperative need to routinely use fluconazole treatment.