变应性支气管肺曲霉菌病八例临床分析并文献复习

Diagnosis and treatment of allergic bronchopulmonary aspergillosis： clinical features of eight cases and literature reviews

目的探讨变应性支气管肺曲霉菌病的临床特征、诊断和治疗。方法分析8例支气管肺曲霉菌病患者的病历资料，并复习有关支气管肺曲霉菌病的文献资料。结果8例患者均有不同程度的咳、痰、喘症状和肺部哮鸣音，其中7例既往有明确的支气管哮喘病史。所有患者均有不同程度的外周血嗜酸性粒细胞升高、血清总IgE和烟曲霉特异性IgE升高以及烟曲霉皮肤点刺试验阳性。6例患者胸部CT影像学表现有肺部渗出性病灶，6例患者有支气管扩张征象。肺功能表现为阻塞性通气功能或以阻塞为主的混合性通气功能障碍。结论支气管肺曲霉菌病的诊断应综合临床表现、血嗜酸性粒细胞升高、血清学IgE水平和烟曲霉皮肤点刺试验等检查；其治疗以糖皮质激素为主，辅以抗真菌治疗。

Objective To study clinical features, diagnosis and treatment of allergic bronchopulmonary aspergillosis （ABPA）. Methods Clinical data and auxiliary examinations of eight patients with ABPA were analyzed, as well as relevant literatures were reviewed. Results All patients had symptom of cough, expectoration, out of breath and wheezing rale, seven of them with history of asthma, and all of them had increased peripheral blood eosinophil （EOS） count, serum levels of total immunoglobulin E （IgE） and IgE specific for Aspergillus fumigatus and showed positive prick test specific for Aspergillus fumigatus. Six of them showed infiltration shadows and six of them showed bronchiectasis in their chest CT images. Lung function test indicated obstructive ventilation dysfunction or mixed ventilation dysfunction with reversible airflow obstruction after administration of bronchodilator. Conclusions Diagnosis for ABPA should be made by integration of clinical features, increased blood eosinophil count and serum level of IgE, and result of prick test specific for Aspergillusfumigatus. Corticosteroid is a mainstay therapy for ABPA, ancillary with anti-fungi therapy. Patients with ABPA should be followed-up to prevent its recurrence.