9例变应性支气管肺曲菌病误诊为肺结核临床分析

Clinical analysis of 9 patients with allergic bronchopulmonary aspergillosis misdiagnosed as pulmonary tuberculosis

目的探讨变态反应性支气管肺曲菌病(ABPA)的临床特点及误诊为肺结核的原因。方法分析9例误诊为肺结核的ABPA的临床表现、发病、影像学表现、诊断和治疗的特点及误诊原因。结果 9例病例均有慢性咳嗽、咳痰,5例有胸闷、喘息,所有病例长时间的误诊。胸部CT显示:单侧和(或)两侧片状浸润影,呈游走,中心性支气管扩张,外周血嗜酸粒细胞增高,血清总IgE高,烟曲菌抗原皮内试验呈速发反应阳性。9例患者用激素及伊曲康唑治疗后症状改善,X线影像学明显吸收。结论 ABPA与肺结核有相似的临床表现和胸部X线影像学表现,临床医生应提高对ABPA的认识。

Objective To investigate the clinical characteristics of allergic bronchopulmonary aspergillosis（ABPA） and the misdiagnosed reasons for pulmonary tuberculosis.Methods The clinical data of 9 ABPA patients misdiagnosed as pulmonary tuberculosis were retrospectively analyzed,which included their clinical characteristics,imaging features,diagnosis and treatment characteristics,and misdiagnosis reasons.Results All cases had chronic cough and sputum,and 5 cases had chest distress and wheeze.The chest CT showed most of this cases were with central bronchiectasis,with high peripheral blood eosinophilia,higher serum total IgE and positive immediate kin-prick test to aspergillus fumigatus.9 cases were better improved by corticosteroid and itraconazole oral application.The clinical manifestations of X-ray were obviously absorbed.Conclusion The main reasons of misdiagnosis is that the clinical characteristics of ABPA are similar to pulmonary tuberculosis in clinical performance and chest X-ray image.The recognition of ABPA should be enhanced.