Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis.
Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis.
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DOI：
10.1186/s12890-022-02175-9
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发表时间：
2022-11-11
影响因子：
3.1
通讯作者：
Xu, Rui
中科院分区：
文献类型：
--
作者：
Xiong, Chunlin;Lu, Jianguo;Chen, Ting;Xu, Rui
关键词：
本研究的目的是进行荟萃分析和系统评价，比较免疫功能正常和免疫功能低下的肺隐球菌病（PC）患者的临床表现和胸部计算机断层扫描（CT）结果的差异。我们使用PubMed、EMBASE、Cochrane Library和Web of Sciences数据库从成立到2021年9月30日对相关研究进行了广泛的搜索。我们纳入了比较免疫功能正常和免疫功能低下的PC患者的临床表现和胸部CT表现的研究。采用纽卡斯尔-渥太华量表（NOS）进行研究偏倚和质量评估。我们的分析纳入了9项研究，涉及248例免疫功能低下和276例免疫功能正常的PC患者。各入选研究的NOS评分均在5分以上，为中度偏倚。免疫抑制组老年患者（> = 60岁）比例显著高于免疫正常组（OR = 2.90, 95% CI (1.31-6.43), Z = 2.63, p = 0.01）。发热（OR = 7.10, 95% CI (3.84 ~ 13.12), Z = 6.25, p < 0.000）和头痛（OR = 6.92, 95% CI (2.95 ~ 16.26), Z = 4.44, p < 0.000）在免疫抑制患者中更为常见。CT薄层表现显示，免疫功能低下者病变多分布于上肺叶（OR = 1.90, 95% CI (1.07-3.37), Z = 2.2, p = 0.028）。免疫功能不全患者出现腔征（OR = 5.11, 95% CI (2.96 ~ 8.83), Z = 5.86, p = 0.00）、毛玻璃衰减（OR = 5.27, 95% CI (1.60 ~ 17.35), Z = 2.73, p = 0.01）、纵隔淋巴结肿大（OR = 2.41, 95% CI (1.12 ~ 5.20), Z = 2.24, p = 0.03）的比例显著高于其他患者。免疫功能低下和免疫功能正常的PC患者在非特异性呼吸道症状方面无显著差异。然而，发热和头痛在免疫功能低下的患者中更为常见。在CT表现中，空洞、毛玻璃衰减和纵隔淋巴结肿大在免疫功能低下的个体中更为常见。在线版本包含补充材料，可在10.1186/s12890-022-02175-9获得。
The purpose of our study was to perform a meta-analysis and systematic review to compare differences in clinical manifestations and chest computed tomography (CT) findings between immunocompetent and immunocompromised pulmonary cryptococcosis (PC) patients. An extensive search for relevant studies was performed using the PubMed, EMBASE, Cochrane Library, and Web of Sciences databases from inception to September 30, 2021. We included studies that compared the clinical manifestations and chest CT findings between immunocompetent and immunocompromised PC patients. Study bias and quality assessment were performed using the Newcastle–Ottawa Scale (NOS). Nine studies involving 248 immunocompromised and 276 immunocompetent PC patients were included in our analysis. The NOS score of each eligible study was above 5, indicating moderate bias. The proportion of elderly patients (> = 60 years old) in the immunosuppressed group was significantly higher than that in the immunocompetent group (OR = 2.90, 95% CI (1.31–6.43), Z = 2.63, p = 0.01). Fever (OR = 7.10, 95% CI (3.84–13.12), Z = 6.25, p < 0.000) and headache (OR = 6.92, 95% CI (2.95–16.26), Z = 4.44, p < 0.000) were more common in immunosuppressed patients. According to thin-section CT findings, lesions were more frequently distributed in the upper lobe (OR = 1.90, 95% CI (1.07–3.37), Z = 2.2, p = 0.028) in immunocompromised individuals. The proportions of patients with cavity sign (OR = 5.11, 95% CI (2.96–8.83), Z = 5.86, p = 0.00), ground-glass attenuation (OR = 5.27, 95% CI (1.60–17.35), Z = 2.73, p = 0.01), and mediastinal lymph node enlargement (OR = 2.41, 95% CI (1.12–5.20), Z = 2.24, p = 0.03) were significantly higher in immunocompromised patients. No significant differences in nonspecific respiratory symptoms were found between immunocompromised and immunocompetent PC patients. Nevertheless, fever and headache were more common in immunocompromised patients. Among the CT findings, cavity, ground-glass attenuation, and mediastinal lymph node enlargement were more common in immunocompromised individuals. The online version contains supplementary material available at 10.1186/s12890-022-02175-9.
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