变态反应性支气管肺曲霉菌病临床特点分析  

Clinical Analysis of Allergic Brochopulmonary Aspergillosis

作　　者：金儿[1] 李婧[1] 马若冰[1] 王利民[1] 任振义[1] 

机构地区：[1]杭州市第一人民医院呼吸内科,310006

出　　处：《医学研究杂志》2013年第2期147-150,共4页Journal of Medical Research

摘　　要：目的分析变态反应性支气管肺曲霉菌病(ABPA)患者的临床特点。方法对笔者医院2006年～2011年25例ABPA患者的临床特点和治疗效果进行回顾性分析。结果 25例患者按病程分急性期(Ⅰ期)13例、缓解期(Ⅱ期)5例、复发加重期(Ⅲ期)4例、激素依赖哮喘期(Ⅳ期)2例、纤维化期(Ⅴ期)1例。20例非缓解期患者的主要症状均为咳嗽喘息,其总IgE都大于1050mg/L,其中4例Ⅲ期患者IgE水平较加重前上升2～5倍。除4例Ⅰ期和5例Ⅱ期患者以外,其余患者血嗜酸性粒细胞均升高。25例患者按胸部CT表现分血清型(ABPA-S)6例,胸部CT表现无异常;中央支气管扩张型(ABPA-CB)12例,表现为中心性支气管扩张和支气管黏液栓形成;其他影像学表现型(ABPA-CB-ORF)7例,其中4例游走性肺内斑点、斑片状浸润。ABPA的治疗效果取决于患者所处的分期,Ⅰ期和Ⅱ期患者的治疗效果好,而Ⅲ期、Ⅳ期治疗相对困难,Ⅴ期患者治疗效果差。结论不同临床分期的ABPA患者具有不同的临床特点和治疗效果,掌握这些特点,不仅有助于早期诊断,而且对于决定患者的治疗方案和评估预后有很大帮助。Objective To study the clinical features of allergic bronchopulmonary aspergillosis（ABPA）. Methods From 2006 to 2011, a total of twenty five patients with ABPA were enrolled in the study. The clinical data were retrospectively reviewed. Results The patients were classified by the course of the disease： 13 cases in acute stage （Ⅰ stage） , 5 cases in remission stage （ Ⅱ stage） , 4 cases in exacerbation stage （Ⅲ stage） , 2 cases in steroid - dependent stage （ Ⅳ stage） , 1 case in fibrotic stage （ Ⅴ stage）. The total IgE level was higher than 1050 mg/L in twenty patients in non -remission stage, which was 2 to 5 fold higher than that before exacerbation in all four stage Ⅱ patients. The absolute eosinophil count was nomal in 9 patients （4 in stage Ⅰ and 5 in stage Ⅱ ） , which was higher in the other patients. The CT findings were nomal in 6 cases of ABPA - seropositive （ ABPA - S） , 12 cases of central bronchiectasis （ ABPA - CB） , 7 cases with other radiologic features （ ABPA - CB - ORF）. Central bronchiectasis and bronchial mucus plug formation was found by Chest CT in twelve patients with ABPA - CB. The treatment effect of ABPA was dependent on the stage of the disease. Compared with the better treatment effect in patients with stage Ⅰ and Ⅱ disease, patients in stage Ⅲ and Ⅳ were relatively difficult to treat, and patients in stage V do have a poor prognosis. Conclusion The results of our study may be helpful in early diagnosis of ABPA, which was important for the treatment selection and prognosis evaluation.

关 键 词：变态反应性支气管肺曲霉菌病 诊断 临床 

分 类 号：R519.8[医药卫生—内科学]