变应性支气管肺曲霉病七例临床特点分析

A dinical analysis of 7 cases of allergic bronchopulmonary aspergillosis

目的探讨变应性支气管肺曲霉病（ABPA）的临床特征、影像学特点、诊断和治疗方法，以做到早期诊断及早期治疗。方法回顾性分析解放军总医院2010年3月至2011年5月确诊的7例ABPA患者的临床资料。结果7例中，男4例，女3例，平均年龄为（33±16）岁。在确诊ABPA前，曾被误诊为支气管哮喘（简称哮喘）6例，肺部感染3例，肺结核2例，支气管扩张1例。主要临床表现为咳嗽6例，咳痰5例，咯血4例（其中3例为黑褐色痰），喘息3例，气短3例，发热2例。7例外周血中总IgE均升高，中位数为3040U／ml。7例外周血中嗜酸粒细胞比均升高，中位数为0．19。6例外周血中嗜酸粒细胞绝对值升高，中位数为1．84×10^9／L；6例曲霉皮肤点刺试验阳性；5例血清特异性烟曲霉IgE抗体升高，平均为（22±15）kU／L；4例血清特异性烟曲霉IgG抗体升高，平均为（108±96）mg／L。胸部cT主要表现为双肺多发性斑片状影、中心型支气管扩张及支气管黏液栓形成。5例患者接受口服糖皮质激素（简称激素）联合抗真菌药物治疗。结论ABPA主要临床特点为常有哮喘病史，胸部影像学显示游走性或固定性肺部浸润影或中心型支气管扩张，外周血中嗜酸粒细胞、血清总IgE水平和血清烟曲霉特异性IgE抗体均升高。对哮喘合并支气管扩张的患者应高度警惕ABPA的可能，应常规进行曲霉皮肤试验筛查，必要时行外周血总IgE及胸部CT检查，以提高ABPA的诊断率。口服激素联合抗真菌药物对ABPA治疗有效。对ABPA患者应注意规律随诊并监测病情的变化，防止病情复发加重。

Objective To study the clinical features, diagnosis and treatment of allergic bronchopulmonary aspergillosis （ABPA）. Methods The clinical presentations, serologic results, chest radiology, pathological results and treatment of 7 patients with ABPA in Chinese PLA General Hospital were retrospectively analyzed. Results There were 4 males and 3 females, with a mean age of （33 ± 16） years. Before the diagnosis of ABPA, 6 cases had been misdiagnosed as bronchial asthma, 3 as pulmonary infection, 2 as tuberculosis and 1 as bronchiectasis. The main clinical manifestations included cough （n = 6 ）, sputum production （ n = 5 ）, hemoptysis （ n = 4）, wheeze （ n = 3 ）, dyspnea（ n = 3） and fever（ n = 2）. All cases had increased total serum IgE levels （ median 3040 U/ml） and peripheral blood eosinophil count （median O. 19）. Six of them showed increased peripheral eosinophil count median 1.84 × 10^9/L, and skin test positive for Aspergillus antigen. Five of them had increased serum IgE antibodies specific to A. fumigatus （22 ± 15） kU/L, and 4 had increased serum IgG antibodies specific to A. fumigatus （ 108 ±96） mg/L. The chest CT scan findings included transient or fixed pulmonary opacities, central bronchiectasis and finger- in-glove opacities. Five patients were treated with corticosteroids combined with antifungal therapy. Conclusions Clinical features of ABPA include a history of asthma, elevation of the total serum IgE levels, presence of aspergillus IgE antibodies, peripheral eosinophilia, and transient or fixed pulmonary opacities and central bronchiectasis. Patients with asthma complicated with bronchiectasis should be routinely screened for Aspergillus skin test, and measurement of total serum IgE levels and chest CT scan are useful for confirmation of the diagnosis of ABPA. Oral glucocorticoids and anti-fungal drugs are effective in treatment of ABPA. Regular follow-up is needed for prevention of recurrence.