基于2017版《变应性支气管肺曲霉病诊治专家共识》的病例分析  

Case analysis based on 2017 version of Expert Consensus on the Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis

作　　者：许洋 刘凯雄 瞿介明[1,2] XU Yang;LIU Kai-xiong;QU Jie-ming(Department of Respiratory and Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Institute of Respiratory Diseases,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院呼吸与危重症医学科,上海200025 [2]上海交通大学医学院呼吸病研究所,上海200025

出　　处：《上海交通大学学报（医学版）》2018年第10期1191-1196,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市重中之重临床重点学科建设项目(2017ZZ02014)~~

摘　　要：目的·以中华医学会呼吸病学分会哮喘学组制定的2017版《变应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)诊治专家共识》(简称《专家共识》)为依据,分析确诊的ABPA病例。方法·依据《专家共识》,回顾性分析上海交通大学医学院附属瑞金医院2013年1月—2017年12月确诊的12例ABPA住院患者的临床资料。结果·12例ABPA患者中,男女各6例,临床表现为咳嗽、咳痰、气喘等,10例血清总免疫球蛋白E(total immunoglobulin E,tIgE)升高,9例外周血嗜酸性粒细胞升高;7例行过敏原皮试速发反应,其中3例霉菌阳性;5例行血清烟曲霉特异性IgE(specifi c IgE,sIgE)检测,均升高;胸部CT多表现为支气管扩张,部分伴黏液栓。完全满足《专家共识》诊断标准的占50.0%。12例均行皮质激素治疗,其中9例联合抗真菌药物。结论·ABPA临床表现多不典型;对于哮喘、支气管扩张等肺病患者,可监测血清tIgE、烟曲霉sIgE和嗜酸性粒细胞水平;行过敏原皮试速发反应及影像学检查,有利于提高ABPA的诊断率;治疗主要为激素联用抗真菌药物。Objective·To analyze the cases of ABPA based on 2017 version of Expert Consensus on the Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis(ABPA)(Expert Consensus in short)developed by Asthma Group of Chinese Medical Association Respiratory Diseases Society.Methods·According to the Expert Consensus,the clinical data of 12 patients with ABPA admitted to Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January 2013 to December 2017 were retrospectively analyzed.Results·Among the 12 patients with ABPA,6 were males and 6 were females.The clinical manifestations were cough,having phlegm,short of breath,etc.The total immunoglobulin E(tIgE)in sera of 10 cases increased,and the peripheral blood eosinophils of 9 cases increased.Seven cases underwent the skin test,3 of whom were positive in aspergillus.Serum aspergillus-specific IgE(sIgE)of all the 5 cases tested was elevated.The most patients showed bronchiectasis in chest CT,and some also with mucus plug.Fifty percent of the cases fully met the diagnostic criteria of Expert Consensus.All the patients were treated with corticosteroid,and 9 of them were also treated with antifungal drugs.Conclusion·The clinical manifestations of ABPA are atypical.For the patients with lung diseases such as asthma and bronchiectasis,serum tIgE,aspergillus sIgE and eosinophil levels need to be monitored.Aspergillus skin test and imaging examination are helpful to the diagnosis of ABPA.The main treatment is the combination of corticosteroid and antifungal drugs.

关 键 词：变态反应性支气管肺曲菌病 专家共识 诊断 治疗 

分 类 号：R562.2[医药卫生—呼吸系统]