慢性阻塞性肺疾病伴肺曲霉病诊治和管理专家共识  

Expert consensus on the diagnosis and treatment of pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

作　　者：中华医学会呼吸病学分会 瞿介明[2] 陈荣昌 陈燕 高莉[5] 沈宁[6] 苏欣 王玮[8] 徐金富 叶枫[10] 张静[11] 张巧 周华[13] 朱迎钢[14] Chinese Thoracic Society of Chinese Medical Association;Qu Jieming;Chen Rongchang(不详;Department of Pulmonary and Critical Care Medicine,Rui-jin Hospital,Shanghai Jiao-tong University School of Medicine,Shanghai 200025,China;Shenzhen Institute of Respiratory Diseases,Department of Respiratory and Critical Care Medicine,Shenzhen People's Hospital,Shenzhen 518020,China)

机构地区：[1]不详 [2]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 [3]深圳市呼吸疾病研究所、深圳市人民医院呼吸与危重症医学科,深圳518020 [4]中南大学湘雅二医院 [5]北京大学第一医院 [6]北京大学第三医院 [7]南京大学医学院附属鼓楼医院 [8]中国医科大学附属第一医院 [9]同济大学附属上海市肺科医院 [10]广州医科大学附属医院 [11]复旦大学附属中山医院 [12]重庆松山医院 [13]浙江大学医学院附属第一医院 [14]复旦大学附属华东医院

出　　处：《中华结核和呼吸杂志》2024年第7期604-622,共19页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：在慢性阻塞性肺疾病(简称慢阻肺)人群中, 肺曲霉病的发病率不断上升, 可表现为侵袭性感染、慢性肺曲霉病、变应性支气管肺曲霉病等多种形式;随着免疫功能等个体状态的变化, 各种形式之间可互相转换甚至并存。同时, 慢阻肺伴侵袭性肺曲霉病多缺乏典型表现, 且部分患者有创检查受限, 给诊断和治疗带来了挑战。为此, 本共识基于循证证据和我国临床实践情况, 对慢阻肺伴肺曲霉病诊治中的重要问题提出推荐意见, 构建临床诊疗路径, 期待为改善疾病管理提供参考和指引。The prevalence of pulmonary aspergillosis is increasing in patients with chronic obstructive pulmonary disease(COPD)and can manifest in different forms such as invasive pulmonary aspergillosis(IPA),chronic pulmonary aspergillosis(CPA)and allergic bronchopulmonary aspergillosis(ABPA).With the variations of individual conditions such as immune status,these forms of the disease may transform into each other or even overlap.Moreover,the atypical clinical manifestations and the limited use of invasive sampling techniques have posed a challenge to the diagnosis and treatment of invasive pulmonary aspergillosis in patients with COPD.To provide recommendations for the management of pulmonary aspergillosis in patients with COPD and to construct a clinical workflow,the consensus panel reviewed the evidence and critically appraised the existing studies.As the majority of the recommendations were supported by low levels of evidence,the evidence levels were not listed in the consensus and the strong and weak recommendations were expressed as“recommend”and“suggest”,respectively.Recommendations for COPD with IPA:The Panel recommends that high-resolution chest computed tomography(HRCT)be performed in patients suspected with IPA.If IPA cannot be excluded by CT scanning,mycological examination of sputum and bronchoalveolar lavage fluid(BALF)is recommended.Bronchoscopy and BALF Aspergillus-related examination are recommended in COPD patients with respiratory symptoms such as dyspnea despite the use of broad-spectrum antibiotics and systemic glucocorticoids and pulmonary infiltrates observed on chest CT.If the diagnosis is in doubt in patients with probable IPA,histopathological examination is recommended.In COPD patients with an acute infection of more than 10 days′duration,the Panel recommended the detection of Aspergillus-specific IgG antibodies in peripheral blood to aid in the diagnosis of IPA,especially in those who cannot obtain BALF.It is not recommended to initiate antifungal therapy based on clinical symptoms suc

关 键 词：慢性阻塞性肺疾病 肺曲霉病 慢阻肺 专家共识 

分 类 号：R563.9[医药卫生—呼吸系统] R519[医药卫生—内科学]