变应性支气管肺曲霉病四例临床分析并文献复习

Clinical Analysis of Four Cases of Allergic Bronchopulmonary Aspergillosis and Literature Review

目的总结变应性支气管肺曲霉病(ABPA)的临床特点、诊断及治疗方法。方法结合文献资料分析我科2009年至2014年确诊的4例ABPA的临床病例。结果 ABPA常发生于支气管哮喘和囊性肺纤维化的患者。临床主要表现为喘息发作、发热、咳嗽、咳痰等症状,实验室检查表现为快速烟曲霉皮试阳性,总血清Ig E水平和曲霉特异的Ig E和Ig G水平上升,以及嗜酸粒细胞增加等;胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和伊曲康唑抗真菌治疗。结论临床上ABPA容易误诊误治,对于未控制的支气管哮喘患者或哮喘患者伴有急性肺浸润,应考虑该病的可能。早期诊断和合理治疗可以减少ABPA造成的肺损伤,改善患者的预后。

Objective To investigate the clinical manifestations,diagnosis and treatments of allergic bronchopulmonary aspergillosis（ ABPA）.Methods The clinical data of four cases of ABPA diagnosed in our department between 2009 and 2014 were analyzed.The related literature was also reviewed.Results ABPA tends to occur in people with chronic lung diseases,such as asthma and cystic fibrosis.The main clinical manifestations are wheezing,fever,cough,and sputum production.Laboratory examinations include immediate Aspergillus skin test reactivity,elevated total serum Ig E and Aspergillus specific Ig E and Ig G antibodies,and peripheral blood eosinophilia.Radiological findings include recurrent chest roentgenographic infiltrates and central bronchiectasis.Treatments involve corticosteroids and antifungal therapy with itraconazole.Conclusions ABPA is easy to misdiagnosis clinically.It should be considered in patients with poor controlled asthma and asthmatic patients with acute pulmonary infiltrates.Early diagnosis and proper treatment can minimize lung injury from ABPA and improve outcomes.