变应性支气管肺曲菌病的诊治最新进展  

Recent advance of the diagnosis and treatment of allergic bronchopulmonary aspergillosis

作　　者：张永祥[1] 刘希芝[1] 王海英[1] 

机构地区：[1]首都医科大学大兴教学医院呼吸内科,北京102600

出　　处：《国际呼吸杂志》2012年第19期1502-1506,共5页International Journal of Respiration

摘　　要：变应性支气管肺曲菌病（allergic bronchopulmonary aspergillosis，ABPA）是机体对烟曲霉过敏引起的一种免疫性肺部疾病，最常见于哮喘和囊性纤维化患者。诊断标准包括慢性哮喘的临床表现、反复肺浸润与支气管扩张、血嗜酸粒细胞增高、血清总IgE增高及烟曲霉皮肤试验阳性等。由于许多ABPA患者症状轻微或无症状，对于哮喘患者一定要想到ABPA的可能，并进一步筛查皮肤试验，以防漏诊。早期诊断可早期给予糖皮质激素治疗，但激素可能要长期应用，激素联合较新的唑类抗真菌药可能更有效。本文对近几年来ABPA的流行病学、发病机制、诊断及处理进行综述。Allergic bronchopulmonary aspergillosis （ABPA） is an immunologic pulmonary disordercaused by hypersensitivity to Aspergillus fumigatus, most often occurring in a patient with asthma or cystic fibrosis. Diagnostic criteria include clinical manifestations of chronic asthma, recurrent pulmonary infiltrates with bronehiectasis, serum eosinophilia, elevated serum total IgE and Aspergillus fumigatus skin test positive, etc. Because many patients with ABPA may be minimally symptomatic or asymptomatie, a high index of suspicion for ABPA should be maintained while managing any patient with asthma, and further screening Aspergillus fumigatus by skin testing to prevent misdiagnosis. Early recognition allows treatment with corticosteroids, which are effective but may be required indefinitely,and combined hormone with newer antifungal azoles may be more effective. This review summarizes the advances in the diagnosis and management of ABPA.

关 键 词：变应性支气管肺曲菌病 哮喘 曲霉菌 

分 类 号：R519.8[医药卫生—内科学]