真菌致敏的严重支气管哮喘三例并文献复习

A retrospective study of 3 cases of severe asthma with fungai sensitization

目的 探讨真菌致敏的严重支气管哮喘（SAFS）的临床特点,提高对该病的诊治水平.方法 回顾性分析杭州市第一人民医院自2005年5月至2009年6月收治的3例SAFS患者的临床特点、治疗方案及预后,同时结合相关文献进行复习.结果 3例患者中女性2例、男性1例,年龄分别为55岁、52岁和61岁,哮喘病史4～40余年;均为哮喘反复发作,真菌皮肤试验阳性,血清IgE＜1000 IU/ml,痰培养均有烟曲霉生长,胸部高分辨CT均未发现支气管扩张和肺部浸润影.2例患者血清半乳甘露聚糖（GM）抗原检测阳性.3例患者确诊SAFS后,加用抗真菌治疗4～22个月,临床喘息症状缓解,复查GM转阴.结论 对于哮喘反复发作且常规治疗效果不佳的患者,如果真菌皮肤试验阳性而 IgE又无明显增高,应考虑到SAFS的可能,加用抗真菌治疗可控制喘息症状.

Objective To describe the clinical features and diagnosis of severe asthma with fungal sensitization（SAFS）.Methods The clinical data of 3 patients of SAFS from this hospital were presented ,and the related literatures reviewed.Results The 3 patients,1 male and 2 females,aging 55,52 and 61years respectively,had a history of asthma for 4 -40 years.All of them presented with severe asthma symptoms,and were found to have fungal sensitization by skin prick testing.Their serum IgE level was less than 1000 IU/ml.A.fumigatus was positive from sputum cultures.There were no radiological abnormalities such as pulmonary infiltrates and bronchiectasis by HRCT in all cases.The serum galactomannan （GM） was positive in 2 patients.After diagnosis,they received additional antifungal therapy for 4 - 22 months,respectively,and the prognosis was good.Conclusion SAFS should be considered in patients with severe asthma and sensitization to fungi but without elevation of serum IgE.Adjunctive antifungal therapy is beneficial for asthma control.