变应性支气管肺曲霉病诊断标准的演变解读  

Evolution of diagnostic criteria for allergic bronchopulmonary aspergillosis

作　　者：蔡润津 冯俊涛[1] Cai Runjin;Feng Juntao(Department of Respiratory and Critical Care,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸与危重症医学科、国家老年疾病临床研究中心,长沙410008

出　　处：《中华结核和呼吸杂志》2024年第12期1176-1180,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：变应性支气管肺曲霉病(ABPA)是一种以对烟曲霉致敏为特征的肺部疾病,患者常表现为反复喘息、非固定性肺部阴影和支气管扩张。由于临床表现的非典型性、机制未明且缺乏统一的诊断标准,ABPA常被误诊和漏诊。1977年,首个诊断ABPA的Rosenberg标准被提出,但未对诊断条目的权重和临界值进行解释;2013年,国际人类和动物真菌学会(ISHAM)提出了更为具体的诊断标准。随着对真菌致敏性疾病认识的深入,变应性支气管肺真菌病(ABPM)的概念亦被提出并日益受到关注。2021年,Asano等提出ABPM诊断标准,发现其诊断敏感度优于Rosenberg和ISHAM标准。2024年,ISHAM再次修订了ABPA诊断标准并提出ABPM诊断标准。本文对ABPA/ABPM诊断标准的演变过程进行梳理、解读,以期有助于该疾病的诊断和治疗。Allergic bronchopulmonary aspergillosis(ABPA)is a lung disease characterized by sensitization to Aspergillus fumigatus.Patients often present with recurrent wheezing,fleeting pulmonary infiltrates,and bronchiectasis.Due to the atypical clinical manifestations,unclear pathogenesis,and lack of unified diagnostic criteria,ABPA is often misdiagnosed or overlooked.In 1977,Rosenberg criteria were introduced as the first diagnostic criteria for ABPA,but without further elaboration on the weighting of diagnostic items and thresholds.In 2013,the International Society for Human and Animal Mycology(ISHAM)proposed more specific diagnostic criteria.As the understanding of fungal sensitization disease has progressed,the concept of allergic bronchopulmonary mycosis(ABPM)has been proposed and has received increasing attention.In 2021,Asano et al.proposed the ABPM diagnostic criteria and found that their diagnostic sensitivity was superior to that of Rosenberg and ISHAM criteria.In 2024,ISHAM again revised the ABPA diagnostic criteria and proposed diagnostic criteria for ABPM.This article provided an analysis and interpretation of the diagnostic criteria for ABPA/ABPM in order to help the diagnosis and treatment of this disease.

关 键 词：诊断标准 支气管扩张 肺部阴影 变应性支气管肺曲霉病 ABPM 反复喘息 致敏性 肺部疾病 

分 类 号：R519[医药卫生—内科学]