变态反应性支气管肺曲霉病临床特点探讨

Clinical characteristics of allergic bronchopulmonary aspergillosis

目的分析变态反应性支气管肺曲霉病(ABPA)的临床特征,以期早期诊断,合理治疗及预防。方法回顾性分析浙江大学医学院附属第一医院2009年6月至2011年7月收治的13例ABPA患者的临床资料,所有患者均依照目前通用的ABPA诊断标准进行诊断,分析其临床表现,影像学特征,治疗方案及疗效等。结果 ABPA好发于中老年患者,且都好发支气管扩张及哮喘患者。13例ABPA患者均有咳嗽,咳痰,8例气喘,4例发热,9例肺部可闻及哮鸣音。13例ABPA患者中有12例CT检查发现囊状或静脉曲张样中心性支气管扩张和支气管粘液栓形成及树芽征为主要特点的小叶中心结节形成。总IgE升高12例,嗜酸粒细胞绝对值升高6例,烟曲菌特异性IgE升高10例。12例接受激素及抗真菌药物治疗,均达到临床症状好转。结论 ABPA临床表现缺乏特异性,为提高对ABPA的认识,对可疑患者早期进行外周血嗜酸性粒细胞数、血清总IgE、烟曲霉菌特异性IgE、肺部CT等检查以确诊,糖皮质激素及伊曲康唑治疗ABPA能取得良好的疗效。

Objective To describe the clinical features of allergic bronchopulmonary aspergillosis （ABPA） for the purpose of early diagnosis, adequate treatment and prevention. Method Thirteen patients diagnosed as ABPA in the First Affiliated Hospital of Zhejiang University were reviewed retrospectively from June 2009 to July 2011. All patients were diagnosed according to the standard diagnostic criterion. Clinical manifestation, imaging features, therapeutic schedule and therapeutic effect were analyzed. Result ABPA occurs typically in middle-aged patients, particularly in patients with bronehiectasis or bronchial asthma. Cough and sputum production were present in all patients in 13 cases ; Wheeze in 8, fever in 4, and wheezing sound could be heard in lung in 9 cases. CT results showed bronchiectasis, bronchial mucoid lmpacfion, and tree buds signs in 12 eases. Total IgE increased in 12 cases, absolute eosinophil increased in 6, and aspergillus fumigatus specific IgE increased in 10. Treatment with hormones and antifungal drug was give to 12 and improvement was achieved in all＇of them. Conclusion Cllnieal manifestation of ABPA is not specific. Early determination of absolute eosinophil count, total IgE and aspergillus fumigatus specific IgE, cortieosteroids and itraconazole can achieve good effect in treatment of ABPA.