变应性支气管肺曲霉病的临床特征及急性加重影响因素  

Clinical features and influence factors for acute exacerbation of allergic bronchopulmonary aspergillosis

作　　者：燕小莉 宋慧 饶会林 YAN Xiaoli;SONG Hui;RAO Huilin(The Third Internal Department,Anhui Chest Hospital,Hefei,Anhui 230022,China)

机构地区：[1]安徽省胸科医院内三科,安徽合肥230022

出　　处：《临床肺科杂志》2024年第10期1485-1489,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的研究变应性支气管肺曲霉病(ABPA)的临床特征和急性加重影响因素,以促进其诊断和治疗。方法回顾性分析2013年2月至2023年3月在安徽省胸科医院首次诊断为ABPA的57例患者的临床和误诊特征,根据随访资料分析其急性加重的影响因素。结果咳嗽、咳痰和喘息是ABPA最常见症状。31例合并哮喘,45例合并支气管扩张。47例有误诊史。合并哮喘容易被误诊(χ^(2)=7.584,P=0.006),伴有中心性支气管扩张(χ^(2)=3.978,P=0.046)和粘液栓(χ^(2)=4.102,P=0.043)不易被误诊。其中35例患者随访2年,13例出现急性加重。与非急性加重者相比,急性加重者总IgE水平更低(Z=-2.133,P=0.033)、支气管扩张比例更高(P=0.015)。结论ABPA临床表现不典型,误诊率和复发率高。总IgE水平低及合并支扩是急性加重的影响因素,可作为临床监测指标。Objective To study the clinical characteristics and influence factors of acute exacerbation of allergic bronchopulmonary aspergillosis(ABPA)in order to improve its diagnosis and treatment.Methods The clinical and misdiagnosis characteristics of 57 patients diagnosed with ABPA for the first time in Anhui Chest Hospital from February 2013 to March 2023 were retrospectively analyzed,and the influencing factors of acute exacerbation were analyzed according to the follow-up data.Conclusion Cough,phlegm and wheezing were the most common symptoms of ABPA.There were 31 cases with asthma and 45 cases with bronchiectasis.47 cases had history of misdiagnosis.Patients with asthma were easily misdiagnosed(χ^(2)=7.584,P=0.006),while patients with central bronchiectasis(χ^(2)=3.978,P=0.046)and mucous embolus(χ^(2)=4.102,P=0.043)were not easily misdiagnosed.Of these,35 patients were followed up for 2 years,and 13 had acute exacerbation.Compared with non-acute exacerbation,patients with acute exacerbation had lower total IgE levels(Z=-2.133,P=0.033)and higher rate of bronchiectasis(P=0.015).Conclusion The clinical manifestations of ABPA are atypical,and the rate of misdiagnosis and recurrence is high.Low total IgE level combined with branch enlargement are the influencing factors for acute exacerbation and can be used as clinical monitoring indicators.

关 键 词：变应性支气管肺曲霉病 临床特征 误诊 急性加重 

分 类 号：R519[医药卫生—内科学]