目的 提高结核病专科医生对肺隐球菌病的认识.方法 回顾性分析武汉市肺科医院(武汉市结核病防治所)2014年1月至2017年5月首诊误诊为肺结核的26例肺隐球菌病的临床特征、实验室检查、CT表现及临床治疗.结果 26例患者中,男18例(69.2％)、女8例(30.8％),年龄22～77岁、平均年龄(49.9±13.9)岁;11例(42.3％)为体检发现肺部阴影无症状就诊,15例(57.7％)因轻微咳嗽、胸闷或胸痛症状就诊;白细胞计数除2例异常外均正常.20例为病理确诊肺隐球菌病,6例为隐球菌荚膜抗原检测阳性、经抗真菌治愈从而确诊肺隐球菌病.16例(61.5％)检测了血清隐球菌荚膜抗原,阳性检出率100.0％(16/16).胸部CT扫描显示,单侧肺受累18例,双肺受累8例,仅2例上下肺野均受累;以肺外周分布(88.5％,23/26)、结节(88.5％,23/26)、多发结节(69.2％,18/26)、晕征(80.8％,21/26)及胸膜增厚(84.6％,22/26)为较常见的CT征象,少见的CT征象为孤立性结节(19.2％,5/26)、肿块(15.4％,4/26))和实变(15.4％,4/26);所有患者均未见淋巴结肿大和胸腔积液.本组患者经氟康唑抗真菌治疗后均临床治愈.结论 肺隐球菌病临床症状轻微,以男性、中老年多见;CT扫描以单侧、单部位受累多见,具有肺外周分布、多发结节、晕征及胸膜增厚等特点,隐球菌荚膜抗原检测肺隐球菌病特异性高,抗真菌治疗后预后良好.“,”Objective To raise the awareness of pulmonary cryptococcosis (PC) among tuberculosis specialists.Methods From January 2014 to May 2017,there were 26 cases of PC misdiagnosed and referred to Wuhan Pulmonary Hospital (Wuhan Institute for Tuberculosis Control).The clinical features,laboratory examinations,chest CT images and treatment of these 26 cases PC were retrospectively analyzed.Results The patients consisted of 18 (69.2％) males and 8 (30.8％) females,with a mean age of (49.9±13.9) years (range,22 to 77).Eleven (42.3％) cases presented with CT image abnormality,but with no clinical symptoms and 15 (57.7％) cases presented with a mild cough,chest tightness or chest pain.White blood cell counts were normal except for 2 cases.Twenty cases were confirmed as PC by pathology,and 6 cases were confirmed as PC through cryptococcal capsular antigen test positive,and the fact that they were cured with antifungal therapy.A total of 16 cases were tested with serum cryptococcal capsular antigen,with a positive rate of 100.0％.Chest CT showed that unilateral lung involvement in 18 cases,and bilateral lung involvement in 8 cases.Only 2 cases were with both upper and lower lung involvement.The common CT imaging features of the PC included peri-pheral pulmonary distribution was 88.5％ (23/26),and the existence of pulmonary nodule was 88.5％ (23/26),including 69.2％ (18/26) with multiple nodule,halo sign 80.8％ (21/26) and pleural thickening 84.6％ (22/26).Rare imaging signs were solitary nodules 19.2％ (5/26),masses 15.4％ (4/26),and consolidation 15.4％ (4/26).No lymph node enlargement and pleural effusion were found in all cases.All patients were clinically cured with fluconazole.Conclusion The clinical symptoms of PC were mild and more common in middle-aged and older males.The imaging of PC was mostly in unilateral and single part involvement,with more peripheral pulmonary distribution and the imaging features were the multiple nodules with the halo sign and the pleural thickening.High specificity of the diagnosis of PC was found by a cryptococcal capsular antigen test.After treatment with antifungal therapy,the prognosis of PC is good.