真菌感染致严重支气管哮喘3例报道  

Case-control study on three cases with severe bronchial asthma caused by fungal infections

作　　者：张平骥[1,2] 夏国光[1,2] 戴丽[1,2] 卞婧[1,3] 张运剑[1,2] 张冰[1,2] 王艳霞[1,2] 王卓[1,2] 

机构地区：[1]北京积水潭医院 [2]北京大学第四临床医学院呼吸内科,北京100035 [3]北京大学第四临床医学院药剂科,北京100035

出　　处：《中华医院感染学杂志》2013年第10期2403-2405,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨真菌感染导致严重支气管哮喘发作临床特点,提高对该病的诊断及治疗水平。方法回顾性分析呼吸科2010年3月-2011年7月收治的3例真菌感染致严重支气管哮喘患者临床表现、实验室检查、影像学特点、治疗方案及预后,并结合相关文献进行复习。结果 3例患者均为女性,年龄分别为81、71、69岁,哮喘病史10～40年;患者均表现为反复哮喘急性发作,均接受长时间大剂量吸入激素、β-受体激动剂和全身口服糖皮质激素治疗且效果不明显;血气分析均表现为2型呼吸衰竭,其中1例行机械通气治疗;痰培养均>2次结果为烟曲霉菌,血清半乳甘露聚糖(GM)抗原阳性;患者血清IgE监测均<1000IU/ml;3例患者胸部CT均未出现支气管扩张表现,2例见多发肺内浸润影、空洞及胸膜下结节,1例CT未见异常;患者均为重症支气管哮喘合并临床诊断侵袭性肺真菌病,1例两性霉素B治疗及另2例给予伏立康唑;3例患者抗真菌治疗6～8周后临床症状明显缓解,ACT评分20～25分,复查痰培养未再发现真菌生长。结论对于反复急性发作的支气管哮喘,同时长时间大剂量吸入激素或口服激素,常规抗感染平喘治疗无效时,应考虑合并侵袭性肺真菌病的可能,及时合理抗真菌治疗可以明显缓解症状,改善预后。OBJECTIVE To investigate the clinical features of the severe bronchial asthma caused by fungal infections so as to improve the diagnosis and treatment of this disease. METHODS The clinical manifestations, laboratory tests, imaging characteristics, treatment programs,and prognosis of three cases with severe bronchial asthma caused by fungal infections who were treated in the respiratory department from March 2010 to Jul 2011 were retrospectively analyzed and were reviewed by combing relevant literature. RESULTS All the 3 three patients were female,with the age of 81, 71 ,or 69 years old , and the history of asthma varying from 10 years to 40 years. All of them had repeated acute episodes of asthma, little effect of long-term and high dose inhaled corticosteroids and β2 receptor agonists and oral corticosteroids. Their arterial blood gas analysis showed that the patients were type 2 respiratory failure. One patient underwent the mechanical ventilation. The Aspergillus furnigatus was tested positive in more than 2 sputum cultures, and serum galactomannan （GM） antigen was tested positive. The patientsrserum IgE was less than 1000IU/ml. Two patients＇ chest CT showed multiple intrapulmonary invasion shadow, no cavities and subpleural nodules. One patientrs chest CT was normal. Bronchiectasis was not found in their chest CT. The diagnosis was severe bronchial asthma and invasive pulmonary fungal. One patient was treated with amphotericin B. Two patients were treated with voriconazole. The clinical symptoms had significantly improved after anti-fungal treatment for 6 to 8 weeks. The ACT scores were at the range of 20 to 25, and no strains of fungi were tested after the re-culture of sputum. CONCLUSION When the repeated acute episodes of asthma patients who used long-term and high dose inhaled corticosteroids or oral corticosteroids have poor effect on the anti-infection and asthma therapy, we should take in mind of the possibility of the invasive pulmonaryfungal diseases and use anti-fungal drug to relieve the sym

关 键 词：支气管哮喘 真菌 感染 

分 类 号：R379[医药卫生—病原生物学]