| [Objective]Reflect the onset,diagnose and treatment of pulmonary cryptococcosis in china mainland in the recent thirty years objectively and literally,in order to provide scientific consult for its clinical diagnose and treatment.[Methods]Index the library on china knowledge web,collect the pulmonary cryptococcosis case reported public by the periodical in our country from 1981.1 to 2008.12.[Results]113 of the 185 pertinent literature retrieved are choiced into meta-analysis.There are at all 728 cases.(1)Basic information:The ratio of the male and female patients is 2.3:1(487:728),the children patients account 3.4%.Most patients is among 40 to 50 years old.(2)Risk factors:The farmers account 34.8%(23/66) in the occupation disposition.In the hapet-history,patients who touched the manure of pigeon accout 12.8%(74/585).There are 69.7%(404/380)of the patients who were healthy before.Other 30.3%(176/580) of the patients who got history of various diseases,the most commen of them areⅢⅤ(3.6%),DM(3.1%),malignant tumors(2.2%),tubercle(3.3%),pulmonary chronic diseases(5.0%),history of operation(2.9%)。(3)Clinical manifestation:1)symptoms:71.5%(434/607)of the patient came to the hospital because of one or more than one symptoms such as cough(50.4 %),expectoration(39.4%),fever(37.9%),chest pain(17.6%),hemoptysis (14.0%),headache(13.5%),tachypnea(4.8%) and night sweat,less of appetite,vomit and weight loss(6.1%).2)medical examination:24%(49/203) of patient are abnormal in physical signs,among them the special abnomal sign out of the respiratory physical sign are:lymphadenectasis of neck (4.9%),splenohepatomegalia(5.4%) and NS(+)(3.9%).(4)laboratory examination:the special results include the decend of CD4+/CD8+29.1 %(25/86),HIV(+)24.4%(21/86).(5)Imagology display:1) the situation of the focus:In 224 patients who got the limited focus,30 patients(13.4 %) are on the left upper field of the lung,62 patients are on the left lower field(27.7%),60 patients are on the right upper field(26.8 %),72 are on the right lower field(34.1%).2)the tye of the focus:75 %of the patients reported get the focus of tumor and nodus(378/434), 18.7%get the focus of foliated shadow(108/434),6.3%get the focus of wildspread mixed focus(34/434).The ratio of single tumor and nodus is 5:3(20/12),the multiple tumor and nodus focus are reported are all nodus focus(0/17),the ratio of single and multiple foliated shadow is 1:1.35 (17/23).3)he size of the focus:The size of the single focus reported is 1.5—3cm(7/18),3.5-5cm(7/18),＞5cm(4/18),the size of the multiple focus reported is＜1.5cm(7/7).4)the edge and density of the focus:In 8 literature,the ratio of regular and irregular single and multiple focus is 1:1.3 and 1.03:1,the ratio of even and uneven in density is 1.03: 1 and 1:1.25.5) the situat ion of the locus on CT:The focus are more common in the right lung than left,the lower lobe than the upper lobe.17cases in 4 literatue reported the multiple tumor and nodus are almost in the lower and out side of the lung under the pleura pulmonalis.The wildspread mixed focus are located on every lobes,the consol shadow are mostly on the lower lobes.6)accompliment signs:in 216 cases reported,the accompaniment signs on chest CT are sublobc:58(26.9%),sentus:57(26.4 %),cavity:43(20.0%),halosign:28(13.0%),lymphadenectasis of hilus and mediastine:23(10.6%),pleura ntrocession:22(10.2%),air bronchogram:22(10.2%),air bronchogra:17(7.9%),pleural effusion:11 (5.1%),vaso-cluster sign:8(3.7%),calcify:4(1.9%).among them the incidence rate of sentus(37.4%),sentus(36.8%)and pleura ntrocession (14.2%)are higher than in the wildspread mixed focus(0.0%)(p＜0.01).The incidence rate of air bronchogram in the foliated shadow focus(42.2%) and in the wildspread mixed focus(12.5%)is higher than in the tumor and nodus focus(0.01%)(p＜0.01),and it is more common in the foliated shadow focus than in the wildspread mixed focus(p＜0.05).the incidence of lymphadenectasis of hilus and mediastine in the wildspread mixed focus(75 %)is higher than in the foliated shadow focus and the tumor and nodus focus(p＜0.01).The incidence of the cavity,vaso-cluster sign and calcify has no difference in the three types of focus(p＞0.05).7)the relationship between the type of focus and the foundation diseases:In 100 cases reported the types of focus in people who were healthy before and people who got foundation illness,the people who got foundation illness get the lower rate of tumor and nodus focus than the people who were healthy before (p＜0.05),but they got the higher rate of wildspread mixed focus than the nomal people on CT(p＜0.01).(6)diagnose:56.7%(310/547) of the patients were final diagnosed by the patho-tissue of the operation,other patient were final diagnosed by the per cutum puncturatio of the lung(20.3 %),the millimicro-skopy check(8.8%),the air tube and humor sample(6.0 %),the ymph node puncture(2.6%),the liquor puris puncture of the focus(0.9%)and autopsy(0.5%).81%(250/310)were misdiagnosed to lung cancer(53.2%),TB(28.0%)and pneumonia(17.6%).84.3%(166/197) of the patient reported got granuloma in the patho-display.(7)the treatment and tumover:The treat styles reported are medicine(36.8 %),operation(27.0%),operation combined with medicine(34.5%).90.2 %of the patients(314/348)are improved or cured,the rate of death and recurrence is 5.8%(20/348)and 4.0%(14/348).58.0%patients used FSZ p.o.,i.v.,or i.v.and p.o.combined in the medicine treatment,other 42 %used amphotericin B combined with the imidazoles.The whole course of treatment is among 3-6 months.91.7%(111/121) of the patients treated by only medicine reported are improved and cured,the rate of death and recurrence if 5.8%(7/121) and 2.5%(3/121).In the 134 patients reported who get the operation,there are 61 patients(45.5%) who get the foucus ectomized,72 patients get the lobe ectomized(53.7%).In the 127 patients reported who get the operation,88.2%of them are improved and cured,the rate of death and recurrence is 3.9%(5/127) and 7.9%(10/127).Between the patients who get the medicine treatment and operation treatment,the rates of improve and cure is(112/127) and 91.7%(111/121),the rate ofrecurrence is7.9%(10/127) and 2.5%(3/121),the rate of death is 3.9 %(5/127) and 5.8(7/121),they have statistic difference in the rate of recurrance(p＜0.05).Between the 145 patients who were heathy before and the patients who got the foundation diseases,the whole rate of improve and cure is 89.4%%(118/132) and 84.6%(11/13),the rate of recurrence is 6.1%(8/132) and 7.7%(1/13) and rate of death is 4.5%(6/132)和7.7%(1/13),the rate of death have statistic difference(p＜0.05).Between the 66 patients who were healthy before and the patients who got foundation disease,after the medicine treatments, the rate of death is 0.0%(0/53) and 11.1%(1/9),the rate of recurrence is 0.0%(0/53) and 11.1%(1/9),the rate of inefficiency is 7.5%(4/53)和111.1%(1/9).they have obvious statistic difference in the rate of recurrence and death(p＜0.01).The patients who had foundation disease get the higher risk of recur and death.Between the patients who got no foundation disease,and presented localizated focus on CT,the rate of death and recurrence in the patients who got the operation is 13.6%(6/44) and 6.8%(3/44),which obvious higner than those who got the medicine treatment only who get the rate of death and recurrence of 0.0%(0/53) and 11.1%(1/9).The rate of death and recurrence in the patients who got medicine treatment after the operation is 8.6%(3/35) and 5.7% (2/35),which is lower than those who got the operation treatment only(P＜0.05).The meningitic patients in PC get 4.4%(11/404) of the onset of illness 20.0%(3/15) of the rate of death.The onset of illness in the meningitic patients who were healthy before is 2.7%(11/404) which is obviously lower than in those patients who got foundation diseases who get the onset of 11.9%(21/176)(p＜0.01).[Conclusions]:1.From 1981 to 2008.12,there are at all 728 PC patients reported by the periodical from the Chinese library in china mainland. Most of patients are adult who get the average age of 40-50 years old.The ratio of the male and female patients is 2.3:1.There are few children patients.2.86.4%of the patients got no contact of bird manure.The most common contact of history is the contact of pigeon manure.3.Famer who contact the earth in long term is one of the occupation factor of PC.4.69.7 %of the PC patients were healthy before.The most common foundation diseases involve HIV,DM,malignant tumor and pulmonary chronic diseases.5.The onset of PC are less of sepcificity in laboratory examination.The main clinical symptom and sign is those which is in the respiratory infection.28.5%of the patients get no clinical 6.The common lab examination is less of specificity.The immune examination has some value in the diagnose.The LA test have some diagnose sense in PC,but has not been developed in the lab in our country.6.PC get some marks on chest CT.The position of the forcus is the right lower lung,the limited forcus are more common in the lower love than the upper lobe.Most of the patients who were healthy before get the single or multiple tumor and nodus focus,the single tumor is usually round and have no fixed size.The multiple focus are usually the multiple nodus focus which get the size of 0.5-1cm,it can be usually irregular.The tumor and nodus focus can be with the sublobe,sentus and pleura ntrocession.The foliate shadow is usually high in density,and can usually appear the air bronchogram symptom.Those who get lower immue function patients usually have widespread mixed foucus,it can also appear lymphadenectasis of hilus and mediastine,pleural effusion,pleural thickening and cavity.Those character of PC on CT have determinal hint sense to the diagnose of the disease.It also helps to distinguish other diseases such as lung cancer and TB.8.Now the final diagnose of PC reply to the operation,otherwise,the per cutem puncturatio of lung and the bronchofibroscope exam is important to the diagnose of PC.9.Most of the patients in our country take active operation and medicine treatment and get good prognosis.The rate of improve and cure of the whole patients is 90.2%.The rate of effective power is 91.7%in the patient who take the medicine treatment only.The whole course of medicine treatment is lower in our country than in other countrys.To those who are nombal in immune infunction and get limited focus,the surgical treatment has higher rate of recurrence and dissemination.Those who have cryptococcal meningitis after operation can have severity infaust consequence.10.To improve the level of diagnose,choose the medicine reasonably and to enhance the consciousness of anti-eumycete medicine treatment are all the problems to be solved in the clinical diagnose and treatment of PC in the future. |
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