变态反应性支气管肺曲菌病20例临床分析

A retrospective study on 20 cases of allergic bronchopulmonary aspergillosis

目的探讨变态反应性支气管肺曲菌病(ABPA)的临床特点。方法回顾性分析20例ABPA的临床表现、发病机制、影像学表现、诊断和治疗的特点。结果20例病人,女13例,男7例,平均年龄40.2岁,均有慢性咳嗽、咳痰、咳棕色痰栓史,15例发作时有胸闷、喘息,听诊闻及哮鸣音,所有病例长时间的误诊。胸部X片:单侧和(或)两侧片状浸润影,呈游走,CT显示中心性支气管扩张,外周血嗜酸粒细胞增高,血清总IgE高,烟曲菌抗原皮内试验呈速发反应阳性。8例患者用激素及伊曲康唑口服治疗,12例单用激素治疗,两组病例在病灶吸收、症状改善无明显差别。结论掌握ABPA的临床特点、诊断和鉴别诊断并不困难。

Objective To discuss the clinical features of allergic bronchopumonary aspergillosis （ABPA）. Methods A review of twenty cases of ABPA with the clinical characteristics, pathogenesis, radiological manifestation, diagnosis and treatment of this disease were performed. Results Twenty cases including thirteen males and seven females, average age 40. 2, have chronic cough, sputum and brown solid sputum. Fifteen patients have chest tightness ,wheeze, and moist crackles when attack. All of this cases was made a wrong diagnosis for a long time. Chest X-ray：unilateral and （or） bilateral lung have muhi-focal or patchy shadows, this shadows were not fixation. CT showed most of this cases were with central brouchiectasis,with high peripheral blood eosinophilia,higher serum total IgE and positive immediate skin-prick test to aspergillus fumigatus. Eight cases treated with corticosteroid and oral itraconazole, twelve cases treated only with corticosteroid, two groups of this cases have no difference in improved the clinical manifestation and focus absorbed. Conclusion Diagnosis of ABPA will be not difficult if its clinical features and differential diaznosis were mastered.