激素联合伏立康唑治疗变应性支气管肺曲霉病18例临床分析

The Clinical Analysis of 18 patients cases with Hormone Combined with Voriconazole in Treatment of Allergic Bronchopulmonary Aspergillosis

目的总结分析变应性支气管肺曲霉病(ABPA)的临床特点及治疗方法,做到早诊断和早期选择最佳治疗方案治疗。方法分析2008年4月至2016年5月江门市中心医院呼吸科确诊的ABPA患者的临床资料。结果共有18例患者,比较常见的症状有:咳嗽(100%),喘息(100%),胸闷(100%)咳痰(22.2%);胸部CT检查常见病变为斑片影(66.7%),中心型支气管扩张(55.6%),痰栓(22.2%),游走性阴影(27.8%)。所有患者均使用糖皮质激素联合静脉伊曲康唑(8例)或伏立康唑(10例),总体有效率为激素联合伊曲康唑5例,激素联合伏立康唑8例。结论 ABPA临床表现缺乏明显的特异性,对可疑患者早期进行外周血嗜酸性粒细胞数,血清总Ig E水平,曲霉抗原皮肤试验,血清曲霉菌变应原沉淀抗体,胸部CT检查等以确诊,并选择适合抗真菌药物联合激素早期治疗。

Objective To summarize and analyze the clinical characteristics of allergic bronchopulmonary aspergillosis （ ABPA） and its therapeutic method in order to diagnose and select the best treatment schedule at the early stage. Methods Patients diagnosed with ABPA in the Pneumology Department of Jiangmen Central Hospital from April 2008 to May 2016 were selected, and their clinical data were analyzed. Results There were 18 cases of patients with the common clinical symptoms of cough （ 100%） , wheeze （100%）, chest tightness （100%）, and sputum plug （22. 2%） . Common lesions found in the chest CT examination were patchy shadow （66. 7%）, central bronchiectasis （55. 6%）, sputum plug （22. 2%） and fleeting shadow （27. 8%）. All the patients in-volved adopted the antenatal corticosteriod therapy of intravenous itraconazole （8 cases） or voriconnazole （10 cases）, and 5 cases with hormone and itraconazole and 8 cases with hormone and voriconnazole proved to be successfully cured. Conclusion The clinical man-ifestation of ABPA lacks obvious specificity. As for the suspected patients, the results of their early examinations were identified, in-cluding peripheral blood hypereosinophilic number, total IgE level of serum, skin test of aspergillus antigen, serum aspergillus Allergen precipitation antibody and chest CT examination, and so on. The proper antifungal drugs combined with hormone were selected for the early treatment.