背景:肺隐球菌病(PC)是一种真菌感染,其预后取决于多种因素。这项研究的目的是分析人类免疫缺陷病毒(HIV)阴性并接受抗真菌治疗的PC患者的肺部病变特征并确定预后因素。
方法:本研究招募了HIV阴性的PC患者。症状,肺部病变的CT特征,血清隐球菌荚膜抗原(CrAg)滴度,潜在的疾病,在2年的随访中评估了抗真菌治疗的持续时间。
结果:共纳入63名患者(40名男性和23名女性),平均年龄为50.4岁。半数患者(50.8%)无症状,最常见的症状是咳嗽(44.4%),咳痰(27.0%),和发烧(17.5%)。肺部病变主要存在于肺的外周和下叶,结节型病变35例,肿块型病变28例。首先,第三,第六,12th,24个月的随访,肺残余病灶比例中位数为59.6%,29.9%,12.2%,9.6%,和0.0%,分别。在抗真菌治疗期间,33例患者的病变达到完全缓解,而其余30名患者则没有。与非CR组相比,CR组有较低的基线血清CrAg滴度(中位数,1:20vs1:80,P<0.01),较小的肺部病变大小(中位面积,1.6cm2对6.3cm2,P<0.01),较低的亨氏单位(HU)放射密度(中位数,-60.0HUvs-28.5HU,P<0.05),结节型病变较多(72.7%vs36.7%,P<0.01),和较少的空气支气管图征象(18.2%和43.3%,P<0.05)。多因素logistic回归分析显示,胸部CT扫描中较大的病灶大小与获得完全缓解的可能性较低相关[OR:0.89;95%CI(0.81-0.97);P<0.05]。
结论:PC在HIV阴性男性中更为常见,胸部CT扫描大多显示结节性病变。抗真菌治疗后,病变较小的患者预后较好.
BACKGROUND: Pulmonary cryptococcosis (PC) is a fungal infection that can have a variable prognosis depending on several factors. The objective of this study was to analyse the characteristics of pulmonary lesions and identify prognostic factors in patients with PC who were human immunodeficiency virus (HIV) -negative and underwent antifungal treatment.
METHODS: The study enrolled patients diagnosed with PC who were negative for HIV. Symptoms, CT characteristics of pulmonary lesions, serum cryptococcal capsular antigen (CrAg) titre, underlying diseases, and duration of antifungal treatment were evaluated over a 2-year follow-up.
RESULTS: A total of 63 patients (40 men and 23 women) with a mean age of 50.4 years were included. Half of the patients (50.8%) were asymptomatic, and the most common symptoms were cough (44.4%), expectoration (27.0%), and fever (17.5%). Pulmonary lesions were mainly present in the peripheral and lower lobes of the lung, with 35 cases classified as nodular-type lesions and 28 cases classified as mass-type lesions. At the first, third, sixth, 12th, and 24th-month follow-ups, the median proportion of residual pulmonary lesions were 59.6%, 29.9%, 12.2%, 9.6%, and 0.0%, respectively. During antifungal treatment, the lesions of 33 patients achieved complete response, while the remaining 30 patients did not. Compared with the non-CR group, the CR group had a lower baseline serum CrAg titre (median, 1:20 vs 1:80, P < 0.01), smaller pulmonary lesion size (median area, 1.6 cm2 vs 6.3 cm2, P < 0.01), lower Hounsfield-units (HU) radiodensity (median, - 60.0 HU vs - 28.5 HU, P < 0.05), more nodular-type lesions (72.7% vs 36.7%, P < 0.01), and fewer air-bronchogram signs (18.2% vs 43.3%, P < 0.05). Multivariate logistic regression analysis showed that a larger lesion size on chest CT scans was associated with a lower likelihood of achieving complete response [OR: 0.89; 95% CI (0.81-0.97); P < 0.05].
CONCLUSIONS: PC was more commonly observed in HIV-negative men, and chest CT scans mostly revealed nodular-type lesions. After antifungal treatment, patients with smaller lesions had a better prognosis.