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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (3): 233-239.doi: 10.3969/j.issn.1000-6621.2020.03.010

• 论著 • 上一篇    下一篇



  1. 1 276002 山东省临沂市人民医院影像科
    2 苏州大学附属第三医院 常州市第一人民医院呼吸与危重症医学科
    3 苏州大学附属第三医院 常州市第一人民医院影像科
  • 收稿日期:2019-12-19 出版日期:2020-03-10 发布日期:2020-03-18
  • 通信作者: 张秋娣

Study on chest CT findings of 55 patients with HIV-negative pulmonary cryptococcosis

ZHANG Ming-hui1,ZHANG Qiu-di2(),ZHANG Su-juan2,SUN Yi-fang3   

  1. 1 Department of Radiology, the People’s Hospital of Linyi,Shandong Province,Linyi 276002, China;
  • Received:2019-12-19 Online:2020-03-10 Published:2020-03-18
  • Contact: Qiu-di ZHANG


目的 探讨HIV阴性肺隐球菌病患者不同免疫状态下的胸部CT特点。方法 收集2012年1月至2018年8月苏州大学附属第三医院和山东省临沂市人民医院临床确诊的55例HIV阴性肺隐球菌病患者的临床资料及胸部CT表现,其中免疫功能正常患者36例,免疫功能抑制患者19例。经活检或手术获取病灶标本的病理检查确诊50例,支气管镜肺泡灌洗液培养确诊1例,隐球菌荚膜多糖抗原乳胶凝集试验阳性并经抗隐球菌治疗有效而临床确诊4例。分析患者肺部病灶类型、病灶特点、分布特点及伴随征象等指标,对免疫功能正常和免疫功能抑制患者的影像学征象发生率进行分析。结果 55例患者中,单发/多发结节/肿块样型最常见(76.4%,42/55),其次为斑片状实变型10例(18.2%),混合型仅3例(5.4%);39例(70.9%)病灶分布于单叶,其中24例(61.5%)位于下叶;45例(81.8%)分布于肺外带;22例(40.0%)周围有卫星灶,磨玻璃样影(4例,7.3%)、胸腔积液(2例,3.6%)、纵隔或肺门淋巴结肿大(3例,5.4%)少见。45例结节/肿块样影中,29例(64.4%)边界清,25例(55.6%)有晕征,17例(37.8%)有支气管充气征,19例(42.2%)有毛刺,4例(21.0%)为粗短毛刺,8例(17.8%)有空洞。累及胸膜的29例病灶中,18例(62.1%)与胸膜呈宽基底贴近。17例行胸部CT增强扫描,其中15例为均匀强化(88.2%),13例(76.5%)为轻度强化。免疫功能正常患者的单发结节/肿块样型(50.0%,18/36)明显多于免疫功能抑制患者(21.0%,4/19)(χ 2=4.342,P=0.037);但卫星灶(30.6%,11/36)、空洞形成率(9.4%,3/32)明显低于免疫抑制患者[分别为57.9%(11/19)、38.5%(5/13)](χ 2=3.873,P=0.049;Fisher精确概率法,P=0.034)。结论 单发/多发结节/肿块样型是HIV阴性隐球菌病患者最常见的CT表现类型,病灶好发于肺下叶、肺外带,晕征、支气管充气征是较常见的CT征象,结节/肿块与胸膜多呈宽基底贴近。免疫功能正常患者多见单发结节/肿块样型,少见卫星灶、空洞。

关键词: 隐球菌病, 肺疾病, 真菌性, 体层摄影术, X线计算机, 诊断显像, 对比研究


Objective The aim of the study is to explore the characteristics of chest CT in patients with HIV-negative pulmonary cryptococcosis (PC) and patients with different immune status. Methods The clinical data and chest CT manifestation of 55 patients with clinical diagnosed HIV-negative PC from January 2012 to August 2018 in the Third affiliated Hospital of Soochow University and the People’s Hospital of Linyi of Shandong Province were collected, including 36 immunocompetent patients and 19 immunocompromised patients. Fifty cases were pathologically diagnosed after biopsy or surgery, one case was diagnosed by bronchoscopic alveolar lavage fluid culture, four cases were diagnosed by cryptococcus capsule polysaccharide antigen latex agglutination test and successful antycryptococcal therapy. The types, characteristics, distribution, accompanying signs of lung lesions and the incidence of imaging signs in immunocompetent patients and immunocompromised patients were analyzed. Results Among the 55 patients, single/multiple pulmonary nodules/masses were the most common (76.4%, 42/55), followed by 10 cases (18.2%) of patchy consolidation, and only 3 cases (5.4%) of mixed type; 39 (70.9%) cases lesions were distributed in a single lobe, of which, 24 (61.5%) were located in the lower lobe; 45 (81.8%) cases were located in the lung periphery; 22 (40.0%) cases were surrounded by satellite foci and ground glass opacity (4 cases, 7.3%), and pleural effusion (2 cases, 3.6%), mediastinal or hilar lymphadenopathy (3 cases, 5.4%) were rare. In 45 cases of nodules/masses, 29 (64.4%) cases were well-defined, 25 (55.6%) cases accompanied with halo sign, 17 (37.8%) cases showed air bronchogram, and 19 (42.2%) cases had spiculation sign, including 4 (21.0%) cases with spinous process and 8 (17.8%) cases with cavity. Among the 29 lesions involving the pleura, 18 (62.1%) were adjacent to the pleural with a wide base. According to the contrast-enhanced CT, 88.2% (15/17) cases were uniformly enhanced, and 76.5% (13/17) were mildly enhanced. Compared with the immunocompromised patients, single nodules/masses were more common (50.0% (18/36) vs. 21.0% (4/19), χ 2=4.342, P=0.037), while the satellite opacities and cavity formation rate were significantly lower (30.6% (11/36) vs. 57.9% (11/19), χ 2=3.873, P=0.049; and 9.4% (3/32) vs. 38.5% (5/13), Fisher’s exact test, P=0.034, respectively) than those in immunocompetent patients. Conclusion Single or multiple pulmonary nodules/masses were the most frequent CT findings in patients with HIV-negative PC. The lesions were more common in the lower lobe and peripheral zone. Halo sign and air bronchogram were more common CT signs. Nodules or masses were more frequently adjacent to the pleural with wide base. Immunocompetent patients were more likely to have a single pulmonary nodules/masses but not satellite opacities and cavity.

Key words: Cryptococcosis, Lung diseases, fungal, Tomography, X-ray computer, Diagnostic imaging, Comparative study