变态反应性支气管肺曲霉病34例临床分析  

Clinical analysis of 34 cases of allergic bronchopulmonary aspergillosis

作　　者：张旭东[1] 李论 高金明[1] 

机构地区：[1]中国医学科学院北京协和医院呼吸内科,100730

出　　处：《国际呼吸杂志》2017年第22期1735-1739,共5页International Journal of Respiration

摘　　要：目的总结变态反应性支气管肺曲霉病（ABPA）的临床特征，增强对ABPA的认识，以期早期诊断和治疗。方法回顾性分析2013年1月至2016年12月在北京协和医院住院确诊的34例ABPA患者的临床资料，包括临床表现、实验室资料、辅助检查等。结果男11例，女23例，发病年龄13～83岁，平均年龄（47．1±19．8）岁。34例均出现咳嗽、喘息，咳痰31例，痰栓6例，气短24例，咯血4例，胸痛2例，发热11例。34例血清总IgE均升高，29例外周血嗜酸粒细胞计数升高，5例BALF中嗜酸粒细胞比例升高；25例血清烟曲霉特异性IgE水平升高，11例特异性IgG水平升高。2例烟曲霉皮肤点刺实验阳性。胸部CT主要表现为双肺多发斑片影、条索影、中心型支气管扩张及高密度黏液栓征。确诊ABPA前，19例曾被误诊为支气管哮喘，6例误诊为肺结核，5例误诊为肺部感染，1例误诊为嗜酸细胞性肺炎。21例接受口服泼尼松联合伊陆康唑治疗。结论ABPA误诊率高，反复发作的哮喘病史是其主要临床特点，胸部CT主要表现为中心型支气管扩张及高密度黏液栓，外周血和BALF中嗜酸粒细胞比例、血清总IgE及烟曲霉特异性IgE／IgG水平升高，口服激素联合抗真菌药物对ABPA治疗有效。Objective To summarize the clinical features of allergic bronchopulmonary aspergillosis （ABPA）,in order to improve the diagnosis and treatment of ABPA. Methods The clinical data of 34 patients who were diagnosed with ABPA and hospitalized in the Peking Union Medical College Hospital from January 2013 to December 2016 were retrospectively analyzed, including clinical manifestations, laboratory findings, and auxiliary examinations. Results There were 11 males and 23 females, aging from 13 to 83 years old, mean age was （47.1 ~ 19.8） years old. All the 34 patients presented with cough and wheeze （ n =34）, sputum production （ n =31）,sputum plugging （ n ~6）, dyspnea （ n =24）,hemoptysis （ n ：4）, chest pain （ n =2）, and fever （ n = 11）. All the 34 patients had increased serum total IgE level. 29 patients had increased eosinophil （EOS） count in peripheral blood and five patients had increased EOS proportion in bronchoalveolar lavage fluid （BALF）. 25 patients had increased serum Aspergillus fumigatus （AF）-specific IgE level and 11 patients had increased AF-specific IgG level. Aspergillus skin test was positive in two patients. Chest CT was characterized by multiple patchy, strip shadows, central cylindrical bronchiectasis and high-density mucous plugging in both lungs. Before diagnosed with ABPA, 19 patients were misdiagnosed as bronchial asthma, six cases as tuberculosis, five cases as pulmonary infection and one case as eosinophilic pneumonia. 21 patients were treated with oral corticosteroids and itraconazole. Conclusions ABPA is easily misdiagnosed as other diseases and recurrent asthma is the main clinical characteristic. Central cylindrical bronchiectasis and high-density mucous plugging are the main characteristics on chest CT. EOS count in peripheral blood and BALF, serum total IgE level, serum AF- specific IgE/IgG levels are all increased. Oral glucocorticoids combined with antifungal agents are effective for ABPA.

关 键 词：变态反应性支气管肺陆霉病 哮喘 诊断 治疗 

分 类 号：R519[医药卫生—内科学]