19例变态反应性支气管肺曲霉病临床分析  

Clinical analysis of 19 cases of allergic brochopulmonary aspergillosis

作　　者：龚瑾[1] 胡必杰[1] 朱惠莉[2] 李向阳[2] 

机构地区：[1]复旦大学附属中山医院肺科,上海200032 [2]复旦大学附属华东医院呼吸科,上海200040

出　　处：《老年医学与保健》2008年第1期33-34,38,共3页Geriatrics & Health Care

摘　　要：目的总结分析不同类型变态反应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)的临床特点,提高对ABPA的认识,做到早诊断早治疗。方法分析中山医院近5年确诊的19例ABPA患者的临床资料,分为变态反应性支气管肺曲菌病-血清IgE增高型组和变态反应性支气管肺曲菌病-中心支气管扩张型组,比较两组病人的临床症状和实验室特点。结果19例ABPA患者中男11例,女8例,在确诊前被误诊为肺结核的有8例,误诊为肺癌的有3例,其他诊断包括支气管哮喘、过敏性肺炎、Wegener肉芽肿等。两组病人在年龄、性别、症状等方面差别无统计学意义,但ABPA伴中心型支气管扩张组的嗜酸粒细胞和血清总IgE水平比血清IgE增高型的ABPA组升高(P<0.01),而第一秒用力呼气容积占预计值百分比则降低(P<0.01)。结论不伴中心型支气管扩张的ABPA可能是疾病的早期或侵袭性较弱的一种形式,为避免肺功能出现不可逆的改变,对气喘、肺部出现游走性浸润影、嗜酸性粒细胞及IgE升高者应进一步查肺CT、烟曲菌特异性IgE和烟曲菌抗原皮内试验,以及早确诊并治疗。Objective To describe and identify different forms of allergic bronchopulmonary aspergillosis （ABPA）. Methods Ninteen cases patients with ABPA included in the study were divided into two groups： 8 patients met the diagnostic criteria of allergic bronchopuhnonary aspergillosis-seropositive （ABPA-S）, and the other patients were diagnosed with ABPA with central bronchiectasis （ABPA-CB）. The clinical presentations, serologic results, lung function data and chest radiology were analyzed. Results The ninteen cases patients iucluded 11 males and 8 females. Initial diagnosis was tuberculosis, lung cancer, asthma, allergic pneumonia and Wegener＇s granulomatosis. There was no significant difference in age, gender and clinical presentations between the two groups. Absolute eosinophil count and total IgE of patients in ABPA-CB group were bigher than those of patients in ABPA-S group. Conclusions The present observations suggest that ABPA includes two forms and ABPA-S may be the mild form of the disease. Early treatment could prevent the disease from progressing to the severe form. Detection of total IgE, A. fumigatus-specific IgE and immediate cutaneous reaction to A. fumigatus is helpful for confirming the diagnosis.

关 键 词：曲霉菌病 变应性支气管肺 分类 诊断 

分 类 号：R519[医药卫生—内科学]