变应性支气管肺曲霉病8例临床疗效分析

A clinical analysis of 8 cases of allergic bronchopulmonary aspergillosis

目的探讨变应性支气管肺曲霉病（ABPA）治疗中可能的复发原因。方法回顾性分析郑州大学第一附属医院呼吸内科2011年8月至2012年8月确诊ABPA的8例患者的临床资料。结果8例患者中男5例，女3例，住院期间给予静脉应用或口服糖皮质激素（简称激素），同时据胸部CT渗出影范围大小应用不同剂型伊曲康唑治疗。其中5例规律门诊随访，1例于出院6周后病情反复再次入院；3例未规律随诊，于出院后2～3个月再次入院。对比未出现病情反复患者（A组）及病情反复患者（B组）的临床资料，分析B组再入院的原因。A组于随诊期间遵医嘱规律减用强的松片[起始剂量0．5mg／（kg·d）]，同时口服伊曲康唑口服液。B组中1例规律随诊，因工作中接触霉菌于出院后6周再入院；1例因激素不良反应自行停用强的松片，1例自行于1个月内将强的松快速减量至停用，二者均继续服用伊曲康唑；1例口服伊曲康唑1个月自行停药。结论对于ABPA患者，应用激素后症状迅速缓解，联合抗真菌治疗能取得较好疗效，单用任意一种治疗均可增加病情复发风险。激素的突然停用及不按疗程服用是病情反复的最大因素，即使抗真菌治疗也不能扭转反复趋势，激素的正确应用是治疗ABPA的基础。治疗中处于高浓度曲霉环境也是病情反复的一个重要因素。

Objective To study the recurrence cause of allergic bronchopulmonary aspergillosis （ABPA） during the treatment. Methods The clinical data of 8 patients with ABPA in the first affiliated hospital of Zhengzhou university from August 2011 to August 2012 were retrospectively analyzed. Results There were 5 males and 3 female. All of them were given glucocorticoids and itraconazole. Five pa- tients were regularly followed, and one of them recurrented after six weeks. Three patients weren＇ t fol- low-up recurrented after 2 to 3 months. Patients gained good effect （group A ） and recurrent patients （group B） was compared, then the recurrence causes of group B was analyzed. Patients in group A in the follow-up period were given reduced dose of prednisione [ initial dose was 0.5 rag/（ kg d） ] , and were given itraconazole at the same time. In group B, 1 case regularly follow-up readmission in 6 months for contact mould on work. One case disabled prednisone for the side effects, one patient reduced the prednisone and disabled in 1 month, both continued to take itraconazole. One patient stopped using itra- eonazole after 1 month. Conclusions Patients of ABPA will be rapidly relieved after using glucocorti- coids, combined with antifungal treatment obtain a good therdpeutic effect, only use one of them may in- crease the risk of recurrence. Discontinuation suddenly and erratic application of the glucocorticoids are important factors of recurrence, even if the antifungal treatment can＇ t change it, the correct application of glucoeortieoids is the foundation for patients with ABPA. Also a high concentration aspergillus environ- ment is an important factor for the recurrence of ABPA.