| Objective:To review the latex latex agglutination test(LAT)test results of patients with normal immune host PCD and the follow-up complete treatment of 19 patients with serum cryptococcal capsular polysaccharide antigen titer and therapeutic efficacy,study LAT method in the diagnosis of normal immune host PCD Summary of changes in cryptococcal capsular polysaccharide antigen titer values and treatment efficacyMethod:Check the 31 patients with PCD and 58 cases of non-cryptococcosis who were diagnosed with normal immunity in the first hospital of Nanchang University from September2015 to March 2018.Collect data on PCD patients' sex,age,history of environmental exposure,main symptoms at the onset of illness,chest radiographs,routine laboratory examinations,etc.,and LAT test results at the first visit.At the same time,the cryptococcal capsular polysaccharide antigen titer values and the changes in the second week,January,March,June,September,and December after treatment in 19 patients who completed the first visit were followed up,and the changes in the condition and medication data.SPSS22.0 statistical software was used for analysis.The four-later table count data analysis LAT method was used to test the sensitivity,specificity,positive predictive value and negative predictive value of the PCD diagnosis,and the2 test(?=0.05).The correlation between the change of titer value and therapeutic efficacy was analyzed and analyzed.Results:(1)The general characteristics of selected cases were: male(19 cases)more than females(12 cases);age between 16-75 years old,average age of 45.5 years;2 cases of history of feeding pigeons,3 cases of history of cultured flowers,no Obviously susceptible to environmental exposure history.(2)Symptoms at the first consultation: Asymptomatic findings were found in 8 cases(25.80%)on physical examination,9 cases(29.03%)in simple cough,4cases(12.90%)in cough + chest pain,2 cases(6.45%)in hemoptysis/bloody stasis,and chest distress One patient had a gas pressure(3.22%),11 cases had fever(35.48%),and 3 cases had extrathoracic symptoms(9.68%).(3)blood test examination: abnormal blood routine(leukocyte12.02-15.55x10^12/L,normal neutrophils,slightly higher proportion of 73-77%,low proportion of lymphocytes)in 4 cases,serum fungal fast GM test Positive in 3 cases;other fungus rapid G test,liver and kidney function,hemoglobin,platelets,coagulation,calcitonin and other no exception.(4)LAT test results: 29 cases were positive in PCD patients,2 cases were negative;2cases were non-PCD cases,and 56 cases were negative.The diagnostic sensitivity was 93.55%,the specificity was 96.55%,the negative predictive value was 93.55%,the positive predictive value was 93.55%,2 = 72.250,P=0.00.There was a statistically significant difference between the LAT diagnosis and the gold standard diagnosis.(5)Thoracic CT: 17 cases(58.64%)with patchy or consolidation,9 cases(29.30%)with nodular or mass shadow,1 case(3.25%)with pleural depression,and hilar,mediastinal lymphadenopathy Two cases(6.45%),one case of a small pneumothorax(3.25%),and one case of mixed signs(3.25%).(6)Among the follow-up patients,the initial antigen titers were 3 in 1:4,3 in 1:8,5 in 1:16,4 in 1:32,and 2 in 1:64.The ratio was 1:320.Three patients were treated with a continuous positive ratio of 1:4 until the full treatment period(9-12 months).None of the 19 patients had recurrence or metastasis during the follow-up period after the completion of the treatment cycle.Conclusions:(1)LAT assay for detection of cryptococcal capsular polysaccharide antigen in blood can be used as an early diagnostic method for PCD,with higher sensitivity and specificity;(2)The higher the antigen titer value at the time of initial diagnosis,the early titer after drug treatment.The faster the rate of decline,the faster the clinical symptoms are relieved,the faster the improvement of lung imaging,and the longer the duration of treatment;(3)The antigen titers in some patients continue to be positive but there are no clinical symptoms and no obvious active imaging lesions,resulting in a pause after the treatment cycle is over.Drugs,no recurrence or metastasis,so the antigen titer value can not be simply treated as the standard of treatment. |
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