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Title: [Dynamic research of serum cryptococcal capsular polysaccharide antigen titer and chest CT of pulmonary cryptococcosis after antifungal therapy].
Author: Lin PC, Ye JR, Zhou Y, Zhang DQ, Xie YP, Chen CS, Li YP.
Journal: Zhonghua Yi Xue Za Zhi; 2019 Jul 09; 99(26):2036-2041. PubMed ID: 31315373.
Abstract:
Objective: To observe the dynamic changes of serum cryptococcal capsular polysaccharide antigen (CrAg) titer and chest CT of pulmonary cryptococcosis (PC) after antifungal therapy. Methods: A retrospective study was performed for patients with PC admitted to the Department of Pulmonary and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University from January 2015 to April 2018. Serum CrAg titers and Chest CT examination were performed for all the cases before and after treatment. The difference between immunocompetent hosts group and immunocompromised hosts group were compared and analyzed. Results: Eighty-two patients with PC including 46 male (56.1%) and 36 (43.9%) female were enrolled. Fifty-two (63.4%) patients were proven PC and thirty (36.6%) patients were probable PC. Forty-five (54.9%) patients had underlying diseases. Fifty-four (65.9%) patients were immunocompetent hosts and twenty-eight (34.1%) patients were immunocompromised hosts. The mean duration of treatment was (7.9±2.4) months and the mean follow-up was (24.0±10.0) months. Improvement (≥75%) in chest CT were found in 64.8% of the cases in immunocompetent group and 67.9% in immunocompromised group after 6 months' treatment. Improvement (≥75%) was found in 88.9% of the cases with patchy infiltrates or consolidation and only 63.0% in nodular or mass-like type and mixed patterns of PC. The serum CrAg titer of 55 cases ranged from 1∶4 to 1∶160 before treatment (median 1∶40) and decreased for all cases after treatment. The serum CrAg titer became negative in 20 cases at last. Mean time of serum CrAg titer turning negative was (11.8±8.1) months. The serum CrAg titer became negative or decreased to 1∶1 in 24 cases after treatment cessation, of whom the serum CrAg titer ranged from 1∶5 to 1∶160 before treatment (median 1∶20). The serum CrAg titer of 31 cases ranged from 1∶4 to 1∶640 before treatment (median 1∶64), of whom the serum CrAg detections were still positive after treatment cessation, and CrAg titer was 1∶10 (ranged from 1∶2 to 1∶160). Conclusions: In PC, chest CT improves after antifungal treatment, and the infiltrates or consolidation type of PC resolves faster than nodular or mass-like shadows and mixed patterns in CT. The serum CrAg titer decreases after antifungal treatment. 目的： 观察胸部CT和隐球菌荚膜抗原（CrAg）试验在肺隐球菌病（PC）治疗中的动态变化。 方法： 回顾性分析2015年1月至2018年4月，温州医科大学附属第一医院呼吸与危重症医学科收治的PC病例。收集临床资料、治疗前后胸部CT表现及血清CrAg试验滴度。根据患者病史和基础疾病是否存在免疫损害或导致免疫抑制易感因素分为免疫正常组和免疫损害组，并进行比较分析。 结果： 82例PC，确诊52例（63.4%），临床诊断30例（36.6%）。男46例（56.1%），女36例（43.9%）。有基础疾病45例（54.9%）。免疫正常组54例（65.9%），免疫损害组28例（34.1%）。抗真菌治疗疗程（7.9±2.4）个月，随访时间（24.0±10.0）个月。抗真菌治疗3~6个月后复查胸部CT，免疫正常组64.8%患者病灶吸收≥75%，免疫损害组67.9%患者病灶吸收≥75%。实变浸润型88.9%患者病灶吸收≥75%，而结节肿块及混合型63.0%患者病灶吸收≥75%。55例PC抗真菌治疗前血清CrAg滴度为1∶40（1∶4~1∶640），治疗后血清CrAg滴度全部下降，20例PC血清CrAg试验滴度最终转阴，转阴时间（11.8±8.1）个月。24例患者停药时血清CrAg试验滴度转阴或降至1∶1，治疗前滴度为1∶20（1∶5~1∶160），31例PC停药时血清CrAg试验滴度未转阴，治疗前滴度为1∶64（1∶4~1∶640），停药时滴度仍为1∶10（1∶2~1∶160）。 结论： PC经抗真菌治疗后，不论免疫损害和免疫正常宿主，胸部CT病灶可明显吸收，其中实变浸润型吸收较快，结节肿块型及混合型吸收缓慢。CrAg经治疗后滴度可逐渐下降。.

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