Role of cryptococcal antigen determination in pulmonary cryptococcosis patients with normal immune function

doi:10.3969/j.issn.1673-8640.2024.12.005

Abstract

Abstract:

Objective To evaluate the role of serum cryptococcal antigen（CrAg） determination in pulmonary cryptococcosis（PC） patients with normal immune function. Methods The clinical data of 60 PC patients with normal immune function at Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University School of Medicine from January 2022 to December 2023 were analyzed retrospectively. The differences in clinical characteristics between serum CrAg negative group and CrAg positive group were compared. The outcome was monitored. Results Among the 60 patients，13 cases had cough and sputum，5 cases had cough and sputum with asthma，3 cases had cough and sputum with chest pain，2 cases had cough and sputum with fever，and the remaining 37 cases（61.7%） had no obvious clinical symptoms. There were 46 cases（76.7%） in serum CrAg positive group and 14 cases（23.3%） in serum CrAg negative group. There was no statistical significance in clinical manifestations of cough，sputum，chest pain，asthma and fever between the 2 groups（P>0.05）. The proportion of multiple nodules in CrAg positive group（71.7%） was higher than that in CrAg negative group（35.7%），and the proportion of single nodules in CrAg positive group（17.4%） was lower than that in CrAg negative group（64.3%）（P<0.05）. There were 15 patients（32.6%）turning to serum CrAg negative within 6 months. Conclusions The determination of serum CrAg can be used to rapidly screen PC patients with normal immune function. It is recommended that CrAg titer is dynamically determined and combined with clinical factors in the course of treatment to provide a reference for the adjustment of treatment plan.

Key words: Cryptococcal antigen, Pulmonary cryptococcosis, Immune function, Clinical characteristic

CLC Number:

R446.62

ZHANG Yan, ZHENG Jie, LIU Jiaxing, GAO Shuo, XU Xuejing, LIU Chang, CAO Xiaoli, ZHOU Wanqing, SHEN Han. Role of cryptococcal antigen determination in pulmonary cryptococcosis patients with normal immune function[J]. Laboratory Medicine, 2024, 39(12): 1157-1162.

Figures/Tables 5

References 27

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诊断依据	确诊	临床诊断
真菌培养	0	0
血清CrAg检测	0	42
组织病理学检查	14	0
血清CrAg检测+ 组织病理学检查	4	0

诊断依据	确诊	临床诊断
真菌培养	0	0
血清CrAg检测	0	42
组织病理学检查	14	0
血清CrAg检测+ 组织病理学检查	4	0

组别	例数	性别				年龄/岁		基础疾病
组别	例数	男/ [例（%）]		女/ [例（%）]		年龄/岁		糖尿病/ [例（%）]		高血压/ [例（%）]		泌尿系统结石/ [例（%）]		脂肪肝/ [例（%）]	无基础疾病/ [例（%）]
CrAg阳性组	46	32（69.6）		14（30.4）		47.0±13.6		1（2.2）		5（10.9）		3（6.5）		2（4.3）	34（73.9）
CrAg阴性组	14	9（64.3）		5（35.7）		50.6±6.4		1（7.1）		1（7.1）		1（7.1）		0（0.0）	7（50.0）
统计值		0.138		0.138		-3.074		0.003		0.000		0.000			2.836
P值		0.710		0.710		0.003		0.955		1.000		1.000		1.000^①	0.092
组别	临床表现								有症状/ [例（%）]		无症状/ [例（%）]		肺部阳性体征/ [例（%）]
组别	咳嗽咳痰/ [例（%）]		胸痛/ [例（%）]		气喘/ [例（%）]		发热/ [例（%）]		有症状/ [例（%）]		无症状/ [例（%）]		肺部阳性体征/ [例（%）]
CrAg阳性组	21（45.7）		3（6.5）		5（10.9）		2（4.3）		21（45.7）		25（54.3）		15（32.6）
CrAg阴性组	2（14.3）		0（0.0）		0（0.0）		0（0.0）		2（14.3）		12（85.7）		2（14.3）
统计值	3.239								3.239		0.446		0.320
P值	0.072		1.000^①		0.329^①		1.000^①		0.072		0.504		0.987

组别	例数	性别				年龄/岁		基础疾病
组别	例数	男/ [例（%）]		女/ [例（%）]		年龄/岁		糖尿病/ [例（%）]		高血压/ [例（%）]		泌尿系统结石/ [例（%）]		脂肪肝/ [例（%）]	无基础疾病/ [例（%）]
CrAg阳性组	46	32（69.6）		14（30.4）		47.0±13.6		1（2.2）		5（10.9）		3（6.5）		2（4.3）	34（73.9）
CrAg阴性组	14	9（64.3）		5（35.7）		50.6±6.4		1（7.1）		1（7.1）		1（7.1）		0（0.0）	7（50.0）
统计值		0.138		0.138		-3.074		0.003		0.000		0.000			2.836
P值		0.710		0.710		0.003		0.955		1.000		1.000		1.000^①	0.092
组别	临床表现								有症状/ [例（%）]		无症状/ [例（%）]		肺部阳性体征/ [例（%）]
组别	咳嗽咳痰/ [例（%）]		胸痛/ [例（%）]		气喘/ [例（%）]		发热/ [例（%）]		有症状/ [例（%）]		无症状/ [例（%）]		肺部阳性体征/ [例（%）]
CrAg阳性组	21（45.7）		3（6.5）		5（10.9）		2（4.3）		21（45.7）		25（54.3）		15（32.6）
CrAg阴性组	2（14.3）		0（0.0）		0（0.0）		0（0.0）		2（14.3）		12（85.7）		2（14.3）
统计值	3.239								3.239		0.446		0.320
P值	0.072		1.000^①		0.329^①		1.000^①		0.072		0.504		0.987

组别	例数	病灶分布
组别	例数	左肺/[例（%）]		右肺/[例（%）]	双肺/[例（%）]	上叶/[例（%）]		下叶/[例（%）]
CrAg阳性组	46	22（47.8）		18（39.1）	5（10.9）	12（26.1）		32（69.6）
CrAg阴性组	14	9（64.3）		4（28.6）	0（0.0）	6（42.9）		7（50.0）
χ²值		1.164		0.161		1.437		1.806
P值		0.281		0.688	0.057^①	0.230		0.179
组别	病变类型					伴随征象
组别	单发结节/[例（%）]		多发结节/[例（%）]			空洞/[例（%）]	晕征/[例（%）]		胸腔积液/[例（%）]
CrAg阳性组	8（17.4）		33（71.7）			4（8.7）	10（21.7）		1（2.2）
CrAg阴性组	9（64.3）		5（35.7）			1（7.1）	1（7.1）		0（0.0）
χ²值	11.624		5.998			0.000	0.078
P值	0.001		0.014			1.000	0.400		1.000^①