变应性支气管肺曲霉菌病不同影像分型的临床特征  

Clinical manifestations in different image types of allergic bronchopulmonary aspergillosis

作　　者：高媛[1] 张薇[1] 周妍[1] 周新佳[2] 郑锐[1] Gao Yuan;Zhang Wei;Zhou Yan;Zhou Xinjia;Zheng Rui(Department of Pulmonary and Critical Care Medicine,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Otolaryngology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院呼吸与危重症科,沈阳110004 [2]中国医科大学附属盛京医院耳鼻咽喉科,沈阳110004

出　　处：《国际呼吸杂志》2021年第12期897-901,共5页International Journal of Respiration

基　　金：辽宁省科学技术基金(2020JH2/10300125)。

摘　　要：目的分析变应性支气管肺曲霉菌病(ABPA)不同影像分型患者的临床表现、血清学、肺功能等特点,提高ABPA早期诊断与治疗。方法对2006年1月至2020年6月中国医科大学附属盛京医院确诊的影像学不同分型的ABPA患者的临床、血清学、肺功能等资料进行回顾性分析比较。结果44例影像学不同分型的ABPA患者主要临床表现为喘息、咳嗽、咯痰,伴有咯血。11.4%的患者误诊结核或肿瘤,6.8%的患者过去曾接受过不适当的抗结核治疗。ABPA伴高衰减黏液栓型(ABPA-HAM)组较ABPA伴支气管扩张型(ABPA-B)组及ABPA血清型(ABPA-S)组患者血清总IgE、外周血嗜酸粒细胞计数及嗜酸粒细胞百分比均明显升高(P值均<0.05)。ABPA-HAM组曲霉特异性IgE较ABPA-S组明显升高(P<0.05)。ABPA-HAM组较ABPA-B组及ABPA-S组患者第1秒用力呼气容积占预计值百分比下降明显,受累的肺段明显增多(P值均<0.05)。结论ABPA-HAM组患者病情更加严重,外周血嗜酸粒细胞计数、血清总IgE和曲霉特异性IgE水平更高,第1秒用力呼气容积占预计值百分比下降明显。早期对哮喘患者进行ABPA特异性检查的筛查,加强哮喘患者的随访,有助于早期诊断。Objective To analyze the clinical manifestations,serology,and pulmonary function of patients with different subtypes of allergic bronchopulmonary aspergillosis(ABPA),and to improve early diagnosis and treatment of ABPA.Methods The clinical,serological,pulmonary function of ABPA patients with different imaging types diagnosed in Shengjing Hospital of China Medical University from January 2006 to June 2020 were retrospectively analyzed.Results Forty-four patients with ABPA of different imaging types showed wheeze,cough,phlegm and hemoptysis.11.4%of patients were misdiagnosed with tuberculosis or tumor,and 6.8% had received inappropriate anti-tuberculosis treatment in the past.The serum total IgE,peripheral blood eosinophil count and percentage of eosinophil cells in ABPA with high-attenuation mucus(ABPA-HAM)group was significantly higher than that in ABPA-B group and ABPA-S group(all P<0.05).The aspergillus specific IgE level in ABPA-HAM group was higher than that in ABPA-S group(P<0.05).ABPA-HAM group had decreased FEV_(1)% pred and more affected lung segments compared with ABPA-B group and ABPA-S group(all P<0.05).Conclusions Patients with ABPA-HAM have more severe symptoms,and higher peripheral blood eosinophil count,higher serum total IgE and aspergillus specific IgE,and significantly decreased FEV_(1)% pred.Early combination of aspergillus specific examination for asthma and follow-up are helpful for early diagnosis.

关 键 词：曲霉菌病 变应性支气管肺 曲霉菌属 IgE 支气管扩张症 高密度黏液栓 

分 类 号：R519[医药卫生—内科学]