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目的探讨不同免疫状态人群隐球菌血症的临床特点。方法对浙江大学医学院附属第一医院(2002年12月至2014年3月)50例隐球菌血症的临床资料进行回顾性分析,根据患者自身免疫情况分成免疫缺陷组(41例)和免疫健全组(9例),对研究病例的性别、发病年龄、临床表现、实验室检查、抗真菌药物及疗效进行分析。结果 50例隐球菌血症中男性30例,女性20例,年龄15~83岁,平均(49±17.0)岁;43例有不同程度发热表现,性别、年龄、平均住院时间、临床表现、白细胞、中性粒细胞比例、C反应蛋白、尿素氮等在两组中差异无统计学意义,免疫缺陷组患者合并隐球菌性脑膜炎、同时合并隐球菌性脑膜炎及肺隐球菌病的病例高于免疫健全组。住院期间死亡10例,病情恶化13例,好转27例。结论隐球菌血症的临床表现不典型,免疫缺陷组较免疫健全组易引起隐球菌血症,免疫缺陷组更易合并隐球菌性脑膜炎及肺隐球菌病,隐球菌血症的预后差。
Objective To investigate the clinical features of cryptococcosis in different immune groups. Methods The clinical data of 50 patients with cryptococcosis admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from December 2002 to March 2014 were retrospectively analyzed and divided into immunodeficiency group (41 cases) and immunization (9 cases). The gender, age of onset, clinical manifestations, laboratory tests, antifungal agents and curative effect were analyzed. Results 50 cases of cryptococcal disease in 30 males and 20 females, aged 15 to 83 years (mean age 49 ± 17.0 years); 43 cases of varying degrees of fever, gender, age, average length of stay, clinical manifestations, leukocytes , Neutrophil ratio, C-reactive protein, urea nitrogen and other differences in the two groups was not statistically significant, immunodeficiency patients with cryptococcal meningitis, combined with cryptococcal meningitis and pulmonary cryptococcal disease cases high In immune-sound group. 10 died during hospitalization, 13 cases of deterioration, improved in 27 cases. Conclusions The clinical manifestations of cryptococcalosis are not typical. Immunodeficiency group is more likely to cause cryptococcal disease than immunocompetent group. Cryptococcal meningitis and pulmonary cryptococcosis are more likely to be associated with immunodeficiency in patients with poor prognosis of cryptococcosis.