北京协和医院77例变应性支气管肺曲菌病住院患者临床特征分析  

Clinical Analysis of 77 Patients with Allergic Bronchopulmonary Aspergillosis in Peking Union Medical College Hospital

作　　者：张明强[1] 高金明[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸内科,北京100730

出　　处：《中国医学科学院学报》2017年第3期352-357,共6页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81170040;81470229);国家科技支撑计划(2012BAI05B00)~~

摘　　要：目的总结变应性支气管肺曲菌病(ABPA)患者的临床特征,增强对ABPA的临床特点认识,以早期诊治。方法回顾性分析了1996年1月至2015年7月北京协和医院住院确诊的77例ABPA患者的临床资料。结果 77例ABPA患者中,男38例,女39例,平均年龄(41.8±18.3)岁。74例(96%)合并支气管哮喘,3例(4%)合并肺囊性纤维化。主要症状有咳嗽(100%)、咳痰(97%)、喘息(86%)、痰栓(25%)、痰中带血(18%)、咯血(9%)、胸痛(9%)、发热(47%)、体重下降(30%)、盗汗(12%)。实验检查主要发现血嗜酸性粒细胞升高(87%)、抗曲菌特异性Ig E升高(89%)、特异性Ig G升高(57%)、曲菌抗原皮试阳性(88%)。肺功能:阻塞性通气功能障碍(66%)、弥散功能障碍(65%)、舒张试验阳性(60%)。胸部CT 72例,中心型支气管扩张(81%)、斑片条索影(79%)、胸膜增厚(49%)、纵隔及肺门多发肿大淋巴结(35%)、结节影(25%)、痰栓征(21%)、游走斑片影(35%)。44例(58%)患者诊断ABPA前误诊为肺结核、肺炎、肺脓肿、肺癌、自身免疫性等疾病。结论 ABPA极易误诊,当支气管哮喘或肺囊性纤维化患者出现喘息、痰栓、血嗜酸性粒细胞增高、中心型支气管扩张、肺内游走斑片影时,应高度警惕合并该病。Objective To summarize the clinical features of allergic bronchopulmonary aspergillosis（ABPA） to facilitate its early diagnosis and treatment. Methods We retrospectively analyzed the clinical data of 77 patients who had been admitted to Peking Union Medical College Hospital from January 1996 to July 2015 with ABPA. Results The average age of these 77 patients（38 men and 39 women） was（41. 8 ± 18. 3）years. The co-morbidities included bronchial asthma（n = 74,96%） and pulmonary cystic fibrosis（n = 3,4%）. The main symptoms and signs of ABPA were chronic cough（100%）, sputum production（97%）,wheeze（86%）, sputum plugs（25%）, blood-stained sputum（18%）, hemoptysis（9%）, chest pain（9%）,fever（47%）,weight loss（30%）,and night sweat（12%）. Laboratory tests revealed elevated levels of blood eosinophils absolute count（87%）,anti-aspergillus antigen-specific Ig E（89%） and specificIg G（57%） as well as a positive result of Aspergillus antigen skin test（88%）. Pulmonary function testing showed that the incidences of obstructive ventilation and diffusion dysfunction were 66% and 65%,respectively;in addition,bronchodilatation test showed positive result in 60% of the patients. The most common CT findings were central bronchiectasis（81%）,patchy infiltrations（79%）,pleural thickening（49%）,mediastinal adenopathy（35%）,nodular opacities（25%）,mucoid impaction（21%）,and fleeting infiltrations（35%）.In addition,44 cases（58%） were misdiagnosed as tuberculosis, pneumonia, lung abscess, and/or lung cancer autoimmune diseases. Conclusions ABPA can be easily misdiagnosed. ABPA should be carefully considered in patients with asthma or pulmonary cystic fibrosis who also suffer from wheeze,sputum plugs,elevated eosinophils central bronchiectasis,and fleeting infiltrations.

关 键 词：变应性支气管肺曲菌病 临床特征 诊断 

分 类 号：R563.12[医药卫生—呼吸系统]