变应性支气管肺曲霉菌病误诊为支气管哮喘临床分析

Clinical Analysis of Allergic Bronchopulmonary Aspergillosis Misdiagnosed as Bronchial Asthma

目的分析变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis,ABPA)的临床特点及诊治方法,以减少误诊。方法对我院收治的误诊为支气管哮喘的ABPA 1例的临床资料进行回顾性分析,并复习相关文献。结果患者因发作性咳嗽、气喘5年,加重15 d入院。曾在外院按支气管哮喘治疗效果不理想。入我院后经肺功能检查及支气管舒张试验诊断为支气管哮喘急性发作,予相应治疗效果不佳。查血清Ig E 1910 U/ml,混合过敏原检测示对尘螨过敏,痰培养见曲霉菌,肺部高分辨率CT检查示中心性支气管扩张,结合临床表现确诊为ABPA。予伏立康唑联合糖皮质激素口服治疗3周后,症状明显好转,痰培养阴性。结论临床上对以哮喘发作样症状为主要表现但按哮喘治疗效果不佳者应高度警惕ABPA,血清Ig E检测、痰培养及影像学检查对其诊断有重要意义。

Objective To analyze the clinical characteristics of allergic bronchial pulmonary aspergillosis and its diagnosis methods,so as to reduce misdiagnosis rate. Methods One case of allergic bronchial pulmonary aspergillosis in our hospital misdiagnosed as bronchial asthma was retrospectively analyzed,and relevant literatures were reviewed. Results The patient was admitted for paroxysmal cough for 5 years and aggravated asthma for half a month. The patient was treated for bronchial asthma but without any improvement. Upon admission to our hospital,the bronchi relaxation and pulmonary function were tested positive,and the patient was diagnosed as having acute bronchial asthma. But the result of corresponding treatment was not satisfactory. Chest CT scanning showed central bronchiectasis; aspergillus was found in sputum culture; GM test was positive,and serum immunoglobulin E（Ig E 1910 U / ml） was tested. For clinical symptoms the patient was diagnosed as having allergic bronchial pulmonary aspergillosis. After treatment of oral voriconazole in combination with hormone for 3 weeks,symptoms were relieved significantly,sputum aspergillus turned negtive. Conclusion Patients presenting asthma symptoms with poor clinical effectiveness should be highly suspected for allergic bronchial pulmonary aspergillosis,and imaging examination,serum immunoglobulin E,bacteria sputum smear examinations have important significance in diagnosis.