糖皮质激素联合抗真菌治疗变应性支气管肺曲霉菌病32例疗效分析

Effect of Glucocorticoid Combined with Antifungal Therapy on 32 Cases Allergic Bronchopulmonary Aspergillosis

目的总结分析糖皮质激素联合抗真菌治疗32例变应性支气管肺曲霉菌病（ABPA）患者的临床特点及疗效，以提高对ABPA的认识。方法回顾分析2009年5月-2014年3月经江苏省人民医院确诊为ABPA的32例患者治疗前及治疗后2个月的临床表现、影像学特征、实验室检查结果及随访情况。结果32例患者其中男性16例，女性16例，确诊年龄为23～83岁，患者中位年龄52岁。临床表现主要为咳嗽、咳痰、喘息、胸闷、咳痰栓、肺部哮鸣音等，影像学表现以斑片影、中央性支气管扩张、黏液栓为主。所有患者均经糖皮质激素联合抗真菌治疗2个月后症状、体征明显改善，肺部影像斑片影、黏液痰栓明显减少。治疗2个月后外周血嗜酸性粒细胞比例由15．04％±9．66％5．06％±5．03％；血清总IgE由1591．52±735．24IU／ml下降至533．37±349．69IU／ml，烟曲霉特异性IgE由13．99±21．32IU／ml下降至8．72±17．53IU／ml，红细胞沉降率由24．75±22．12mm／h下降至14．63±12．90mm／h，血清CEA由5．80±4．39ng／ml下降至3．36±1．66ng／ml，差异有统计学意义（P均〈0．05）。相关性分析显示，治疗前、后外周血嗜酸性粒细胞比例均与血清总IgE水平呈正相关（分别为r=0．623，P=0．000；r=0．472，P：0．006）；治疗前血清CEA水平与血清总IgE水平呈正相关（r=0．615，P=0．000）。结论咳嗽、咳痰、喘息为ABPA最常见的临床症状，糖皮质激素联合抗真菌治疗可明显提高疗效；症状的好转、影像学表现的改善及血清总IgE、外周血嗜酸性粒细胞比例、烟曲霉特异性IgE抗体、血沉的下降可作为ABPA疗效评估的指标。

Objective To enhanced the understanding of Allergic Bronchopulmonary Aspergillosis（ABPA） ,we summarized the clinical characteristics and curative effects of 32 cases patients of ABPA. Methods Totally 32 cases of ABPA who had been diagnosed in Jiangsu province hospital between May 2009 and March 2014 were studied in their clinical manifestations, imaging characteristics, laboratory results and follow - up results retrospectively. Results Totally 32 patients included 16 males and 16 females, age from 23 to 83 and the median aged was 52. Their main clinical manifestations included cough, sputum, wheeze, chest tightness, cough up sputum plug, lung wheezing sound, besides the imaging findings showed as patch shadows, central bronehiectasis and mucus plugs. After 2 months being treated with glucocorticoid combined antifungal, the signs and symptoms improved, and the patch shadows in lung image, even the mucus plugs all decreased significantly. The peripheral eosiuophil ratio reduced from 15.04%± 9.66% to 5.06% ± 5.03% , the serum total IgE decreased from 1591.52 ±735.24IU/ml to 13.99 ± 21.32IU/ml, the aspergillus fumigates -specific IgE decreased from 13.99 ±21. 321U/ml to 8.72 ± 17.53IU/ml, the blood sedimentation decreased from 24, 75 ±22.12mm/h to 14.63 ± 12.90mm/h, the serum CEA decreased from 5.80 ±4.39ng/ml to 3.36 - 1.66ng/ml, and all the differences were statistically significant （ all P 〈 0.05 ）. Correlation analysis indicated that peripheral eosinophil ratio were positively correlated with serum total IgE level pre - and - post treatment （respectively r = 0. 623, P = 0. 000 ;r = 0. 472, P = 0. 006）. Serum CEA levels were positively correlated with serum total IgE levels before treatment （r =0. 615, P = 0. 000）. Conclusion The most common clinical symptoms of ABPA were cough, sputum and wheeze. The combination of glueocorticoid and antifungal treatment can obviously improve the curative effects. These markers such as the improvement of the symptoms, the imaging findings, the serum total IgE, the peripheral blood eosinophilia granulocyte ratio, the inducing aspergillus fumigates -specific IgE antibody and the blood sedimentation may be used as ABPA curative effect evaluation indicators.