| Objective:To summarize the characteristics of AIDS and non-AIDS patients with pulmonary cryptococcosis in the age,sex,history of exposure,clinical symptoms,laboratory tests,CT imaging performance and other aspects,provide a reference for the diagnosis and treatment of clinical pulmonary cryptococcosis.Methods:A retrospective statistical analysis method was used to select 147 pathologically confirmed and clinically diagnosed patients with pulmonary cryptococcosis in Sir Run Run Shaw Hospital of Zhejiang Province and Xixi Hospital of Hangzhou from February 2012 to June 2017.Among them,there were 21 AIDS patients and 126 non-AIDS patients,all patients were collected clinical data,including general demographic characteristics,the combined basic diseases,clinical manifestations,laboratory tests,imaging findings,etc.,The collected data were analyzed using SPSS 17.0 statistical software.The numerical data that accord with the normal distribution were represented by((?)±s),t-test or chi-square test was used to compare between groups.Results:1.Inclusion of 147 patients with pulmonary cryptococcosis,aged 16?78 years old,the average age was(43.09±14.33)years,there were 91 males(61.9%)and 56 females(38.1%).According to the subgroup data,the average age of the AIDS group was(38.90±13.35),17 males(81.0%)and 4 females(19.0%).The average age of non-AIDS patients was(45.40±14.09)years.There were 74(58.7%)males and 52 females(41.3%).There was no significant difference in age and gender distribution between the two groups.2.Four patients with pulmonary cryptococcosis had pigeon faeces or decayed wood contact history,and 143 patients had no definite contact history of pigeon droppings and decayed wood.94 cases of patients with one or more other underlying diseases(including all AIDS patients),with AIDS,hypertension,diabetes,liver disease and more common,53 patients did not merge with other underlying diseases.3.64 cases of patients with pulmonary cryptococcosis did not show any clinical symptoms,among the 83 patients with symptoms,cough(53 cases,36.1%),sputum(28 cases,19.0%),chest pain(23 cases,15.8%)and fever(19 cases,12.0%)were more found.Asymptomatic patients in AIDS group were significantly less than those in non-AIDS group(p<0.05).The clinical manifestations of AIDS patients were mostly fever,cough and sputum,accounting for 71.4%,52.4%and 33.3%respectively of the patients in this group,the clinical manifestations of cough,expectoration,fever and chest pain were more common in non-AIDS patients,accounting for 61.9%,42.9%,28.6%and 19.0%of the patients in this group.The incidence of fever in AIDS group was significantly higher than that in non-AIDS patients(p<0.05).4.In 147 cases of patients with pulmonary cryptococcosis,the majority of patients had a normal range of white blood cell count,neutrophil percentage,C-reactive protein and erythrocyte sedimentation rate,and the AIDS patients were relatively higher than those of non-AIDS patients,the difference was not statistically significant(p>0.05).AIDS patients were significantly higher in the incidence of laboratory abnormalities than non-AIDS patients(p<0.05).The levels of CD4+ T lymphocytes in AIDS group were(0.13±0.10)*103/?L,which were significantly higher than those in non-AIDS patients(p<0.05).5.The positive rate of CrAg in 147 patients with pulmonary cryptococcosis was 86.9%.The positive rate of CrAg in AIDS patients was 100%and that in non-AIDS patients was 84.7%.There was no significant difference(p>0.05).6.Of the 147 patients with pulmonary cryptococcosis,64(43.5%)had lesions that were found in two or more lobes and 83(56.5%)were limited to a single lobe with most of the lesions at Lower lobe(40.1%).There were 46 patients(31.3%)with lesions in bilateral lungs and 101(68.7%)in unilateral lungs,including 37(36.6%)in the left lung and 64(63.4%)in the right lung.There were 57(38.8%)cases with solitary lesions and 90(61.2%)cases with multiple lesions;93(63.3%)with subpleural lesions,and 54 patients(36.7%)without subpleural involvement.15 patients(71.4%)had multiflora lesions in the AIDS group and 6(28.6%)in the single lobe.In the non-AIDS group,there were 49 cases(38.9%)of multiple lobes and 77(61.1%)single lobes,there was significant difference between the two groups in the distribution of multiflora lesions or single lobe(p<0.05).In the AIDS group,there were 11 patients(52.4%)with lesions distributed in both lungs and 10 patients(47.6%)with single lungs,and there were 35(27.8%)patients and 91(72.2%)patients in the corresponding non-AIDS group,there were significant differences in the distribution of lung lesions or single lung between the two groups(p<0.05).8 patients(38.1%)had subpleural lesions in AIDS group,13(61.9%)patients in non-subpleural.In the non-AIDS group,there were 85 cases(67.5%)of subpleural patients and 41 cases(32.5%)of non-subpleural.There was significant difference between the two groups in subpleural or non-subpleural location(p<0.05).7.Of the 147 patients with pulmonary cryptococcosis,78(53.1%)had nodules or mass lesions,of which 48(32.7%)had single nodules or masses and multiple nodules or masses Type of 30 cases(20.4%).There were 33 cases(22.4%)of the patients with focal infiltration.Among them,9(6.1%)were single infiltrative and 24(16.3%)were multiple infiltrative infiltrative.33 cases(22.4%)showed mixed lesions and 3(2.0%)had interstitial pneumonia.AIDS patients showed nodules or mass lesions in 7 cases,significantly lower than non-AIDS group(p<0.05).There were 3 patients(14.3%)in the AIDS group with interstitial pneumonia,which were significantly higher than those in the non-AIDS group(0)(p<0.05).36 patients(24.5%)had no evidence of concomitant image performance,47(32.0%)cases had signs of haloration,43(29.2%)had voids,31(21.1%)cases had bronchial inflatable sign,and there were 15 cases(10.2%)with lobulation,15 cases(10.2%)with burr,2 cases(1.4%)with calcification,25 cases(17.0%)with pleural recess and 6 cases(4.1%)with pleural effusion,in 2 cases(1.4%)with Lymph node enlargement,1 case(0.7%)with pericardial effusion.1 patient in the AIDS group with no concomitant image performance and was significantly lower than the non-AIDS group(35 patients)(p<0.05).In the AIDS group,there were 11 cases presenting with an empty sign,32 cases in the non-AIDS group,12 cases with the halo sign,35 cases in the non-AIDS group,0 cases with the calcified group,2 cases in the non-AIDS group,3 cases with burr sign,12 cases in the non-AIDS group,7 cases with bronchial inflatable sign,24 cases in non-AIDS group,7 cases with lobulation,8 cases in non-AIDS group,3 cases with pleural effusion,3 cases in non-AIDS group,7 cases with pleurodesis,18 cases in non-AIDS group.The incidence of halo sign,empty sign,lobulation sign and pleura in AIDS group were significantly higher than those in non-AIDS group(p<0.05).There was no significant difference in bronchial inflatable sign,burr sign,calcification,pleural effusion,lymph node enlargement and pericardial effusion between the two groups(p>0.05).Conclusion:1.Pulmonary cryptococcosis was more common in young and middle-aged patients,more male than women,both in AIDS and in non AIDS patients.2.Only a few cases of AIDS and non-AIDS patients with pulmonary cryptococcal pigeon or decayed wood contact history,history of contact with the exclusion or diagnosis of cryptococcal infection was of little significance.In patients with pulmonary cryptococcosis,the number of patients without underlying diseases accounted for about one-third,whether suffering from underlying diseases to exclude or diagnose pulmonary cryptococcal disease was of little significance.3.Some patients with pulmonary cryptococcosis without any clinical symptoms,more common in non-AIDS patients.Pulmonary cryptococcal disease showed no specific clinical symptoms,and fever was more common in patients with AIDS,the other more common was cough and sputum Symptoms.The symptoms of Cough,expectoration,fever,chest pain was more common in non-AIDS patients.4.Patients with pulmonary cryptococcosis have no specific changes in laboratory tests.AIDS was more likely to have the above-mentioned indicators of leukocyte count,neutrophil percentage,erythrocyte sedimentation rate and C-reactive protein level than non-AIDS patients abnormal.AIDS patients with CD4+ T lymphocyte counts were significantly lower than non-AIDS patients,and lower than normal,help to screen AIDS patients.5.Serum capsular polysaccharide latex agglutination test for the diagnosis of AIDS complicated with pulmonary cryptococcosis patients have a higher sensitivity.6.The distribution of pulmonary cryptococcosis more widely and randomly,compared with non-AIDS patients,AIDS patients were mostly multi-lobe lesions or bifid distribution,and the lesions were more than in the non-subpleural.7.The lesions of the pulmonary Cryptococcus were varied on CT images,with more nodules or mass shadows,flaky infiltrates,or mixed shadows.More than 20%of patients may have empty sign or bronchial inflatable sign.Nodules or mass shadow were more likely to occur in non-AIDS patients and interstitial pneumonitis was more likely to occur in AIDS patients.Patients with AIDS were more likely to have halo sign and void sign. |
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