肺内外隐球菌感染病例的临床特征分析

doi:10.3969/j.issn.1006-7795.2021.02.028

摘要/Abstract

摘要： 目的总结肺内外隐球菌感染患者的临床特点,分析肺外隐球菌感染的独立危险因素。方法分析2014年1月至2019年12月间首都医科大学附属北京朝阳医院隐球菌感染住院患者的基本临床资料、临床表现、实验室检查、诊断治疗及转归,根据是否有肺外累及分为肺隐球菌感染组(pulmonary cryptococcal infection,PC)和肺外隐球菌感染组(extrapulmonary cryptococcal infection,EPC),用统计学方法对两组资料进行分析,用Logistic回归分析法分析隐球菌播散至肺外的危险因素。结果共收集病例51例,其中男性30例,女性21例,年龄中位数为55(40,64)岁,合并基础疾病者39例。其中PC组41例,EPC组10例。EPC组实体器官移植和慢性肝病的比例(40.0%和40.0%),高于PC组(7.3%和7.3%),差异有统计学意义(P<0.05);EPC组患者出现头痛症状的比例(50.0%),高于PC组(2.4%),差异有统计学意义(P<0.05);EPC组降钙素原、门冬氨酸氨基转移酶、肌酐高于PC组,差异有统计学意义(P<0.05);EPC组白蛋白、外周血CD4⁺T细胞、外周血CD8⁺T细胞低于PC组,差异有统计学意义(P<0.05);EPC组病死率(60.0%)高于PC组(2.4%),差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示实体器官移植(OR=10.470,95%CI为1.089~100.651,P=0.042)和白蛋白降低(OR=0.783,95%CI为0.637~0.962,P=0.020)与出现肺外隐球菌感染独立相关。结论肺外隐球菌感染患者比肺隐球菌感染患者预后差,实体器官移植和白蛋白降低是肺外隐球菌感染的独立危险因素。

关键词: 隐球菌, 肺隐球菌感染, 肺外隐球菌感染, 器官移植

Abstract: Objective The aim was to summarize the clinical characteristics of patients with pulmonary and extrapulmonary cryptococcal infection and analyze the independent risk factors of extrapulmonary cryptococcal infection.Methods Data of inpatients with cryptococcal disease who were admitted in Beijing Chaoyang Hospital, Capital Medical University from January 2014 to December 2019, including clinical data, clinical manifestations, laboratory examination, diagnosis, therapy and prognosis were analyzed. According to the prognosis, the patients were divided into pulmonary cryptococcosis group (PC group) and extrapulmonary cryptococcosis group (EPC group). The data of the two groups were analyzed by statistical method. The multivariable Logistic regression analysis was used for risk factors of extrapulmonary infection. Results A total of 51 cases, 30 males and 21 females, with the median age of 55(40, 64) years, were collected. Totally 39 cases were complicated with basic disease. There were 41 cases in PC group and 10 in EPC group. The proportion of solid organ transplantation and chronic liver disease(40.0% and 40.0%) in EPC group was higher than that in PC group(7.3% and 7.3%), the difference was statistically significant (P<0.05). The incidence of headache in patients with EPC group(50.0%) was higher than that in PC group (2.4%), the difference was statistically significant(P<0.05). The levels of procalcitonin, aspartate transferase and creatinine in EPC group were higher than those in PC group, the difference was statistically significant(P<0.05). Albumin, peripheral blood CD4⁺ T cells and peripheral blood CD8⁺ T cells in EPC group were lower than those in PC group, the difference was statistically significant(P<0.05). The mortality rate of EPC group (60.0%) was higher than that of PC group (2.4%), the difference was statistically significant(P<0.05). Multivariable Logistic regression analysis showed that solid organ transplantation(OR=10.470, 95%CI:1.089-100.651, P=0.042) and lower serum albumin (OR=0.783, 95%CI:0.637-0.962, P=0.020) were independent risk factors for extrapulmonary infection. Conclusion The prognosis of patients with extrapulmonary cryptococcal infection is worse than that of patients with pulmonary cryptococcal infection. Solid organ transplantation and low albumin are independent risk factors for extrapulmonary cryptococcal infection

Key words: cryptococcus, pulmonary cryptococcosis, extrapulmonary cryptococcosis, organ transplantation

中图分类号:

R446

王超宇, 隗明, 刘永哲, 陈云霞, 谷丽. 肺内外隐球菌感染病例的临床特征分析[J]. 首都医科大学学报, 2021, 42(2): 328-333.

Wang Chaoyu, Wei Ming, Liu Yongzhe, Chen Yunxia, Gu Li. Clinical features of pulmonary and extrapulmonary cryptococcal infection[J]. Journal of Capital Medical University, 2021, 42(2): 328-333.

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