不同免疫状态肺隐球菌病患者的临床特征：中国一项为期 10 年的多中心回顾性研究。

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2024-11-15 DOI:10.1016/j.rmed.2024.107866

Hansheng Wang , Wenya Han , Chengqing Yang , Hongling Hu , Yulan Zheng , Li He , Miaojuan Zhu , Qiujie Tu , Lulu Nan , Fuying Hu , Wentian Li , Yijun Tang , Meifang Wang

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引用次数: 0

摘要

背景和目的：我们旨在评估肺隐球菌病（PC）在大型多中心人群中不同免疫状态患者的临床特征和疗效，以支持对这一公共卫生威胁的适当临床管理：我们回顾性调查了2014年1月至2023年6月期间中国湖北省10家具有代表性的区域性三级教学医院的510例PC患者的病历，然后按照不同的免疫状态对这些患者的临床数据进行分层：免疫功能正常（IC）患者占68.8%（351/510），轻中度免疫缺陷（MID）患者占16.7%（85/510），重度免疫缺陷（SID）患者占14.5%（74/510）。MID组和SID组PC患者中枢神经系统（CNS）受累的发生率高于IC组[4.7%（MID） vs. 8.1%（SID） vs. 1.1%（IC），P = 0.002]。发热患者在 SID 组（35.1%，26/74）中更为常见（P=0.002）：PC在华中地区的发病率正在上升，尤其是免疫功能正常的PC人群。此外，免疫抑制和免疫功能健全的 PC 患者在年龄、全身症状、某些影像学特征和某些实验室结果方面存在显著差异。最后，PC 患者的局限性结节/肿块和轻微症状常常导致误诊和不必要的肺切除，而 CrAg 检测有助于早期无创诊断。

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Clinical characteristics of pulmonary cryptococcosis patients with different immune statuses: A 10-year multicenter retrospective study in China

Background and objective

We aimed to evaluate clinical characteristics and therapeutic efficacy of pulmonary cryptococcosis (PC) in patients with different immune status in a large multicenter population to support appropriate clinical management of this public health threat.

Methods

We retrospectively investigated the medical records of 510 patients with PC from January 2014 to June 2023 in 10 representative regional tertiary teaching hospitals in Hubei province of China, and clinical data of these patients were then stratified by different immune statuses.

Results

Immunocompetent (IC) patients accounted for 68.8 % (351/510), mild-to-moderate immunodeficiency (MID) patients accounted for 16.7 % (85/510), and severe immunodeficiency (SID) patients accounted for 14.5 % (74/510). PC patients in the MID and SID groups had a higher incidence of central nervous system (CNS) involvement than that in the IC group [4.7 % (MID) vs. 8.1 % (SID) vs. 1.1 % (IC), p = 0.002]. Patients with fever in SID group (35.1 %, 26/74) was more common (p < 0.01). Solitary nodule/mass were more common in the IC group than the MID and SID groups (p < 0.05); in contrast, diffuse nodules in MID or SID groups was significantly greater than that in IC groups (p < 0.01). The follow-up showed that the overall treatment improvement rate for PC showed a significant difference between the 3 groups [90.3 % (IC) vs. 75.3 % (MID) vs. 54.1 % (SID), p = 0.00].

Conclusion

The incidence of PC is increasing in Central China, especially for the immunocompetent PC population. In addition, there are significant differences in age, systemic symptoms, certain radiographic characteristics and some laboratory results between immunosuppressed and immunocompetent PC hosts. And finally, limited nodules/masses and mild symptoms in patients with PC often lead to misdiagnosis and unnecessary pulmonary resection, but CrAg assay contributes to early noninvasive diagnosis.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.