变应性支气管肺曲霉病合并侵袭性肺曲霉病病例临床分析

Allergic bronchopulmonary aspergillosis complicated with invasive pulmonary aspergillosis in 4 clinical cases

目的分析变应性支气管肺曲霉病(ABPA)合并侵袭性肺曲霉病(IPA)患者的临床特点,提高临床对该病的诊治水平。方法回顾性分析2015年1月-2017年12月北京朝阳医院京西院区收治的4例ABPA合并侵袭性肺曲霉病患者的临床特点。结果 4例ABPA合并IPA患者其IPA诊断为临床诊断病例,入院前均有糖皮质激素全身应用史;BAlF的GM检测均>1μg/L为阳性,血GM检测结果均>0.5μg/L,其中1例>1μg/L;影像表现为结节影伴晕征、空洞、肿块影等典型曲霉菌感染征象;BALF涂片可见大量菌丝,培养结果为曲霉菌属;4例患者均给予抗真菌治疗,3例患者临床好转,1例死亡。结论 ABPA合并侵袭型肺曲霉菌患者,其病情相对复杂和严重,BALF的GM检测有助于尽早明确诊断,采取敏感的抗真菌药物治疗为基础的综合措施,可改善患者预后。

OBJECTIVE To investigate the clinical characteristics of the allergic bronchopulmonary aspergillosis（ABPA）patients complicated with invasive pulmonary aspergillosis and improve the level of clinical diagnosis and treatment of the disease.METHODS The clinical characteristics of 4 ABPA patients complicated with IPA who were treated in west part of Beijing Chaoyang Hospital from Jan 2015 to Dec 2017 were retrospectively analyzed.RESULTS The IPA was diagnosed as a clinical diagnosis in the 4 ABPA patients complicated with IPA,all of whom had the history of systemic use of glucocorticoids.The GM test of BAlF was positive and was more than 1μg/L,all of the results of the blood GM test were greater than 0.5μg/L and was greater than 1μg/L in 1 case.The imaging findings were characterized by the signs of typical Aspergillus infection such as nodules,cavity,and tumor.The results of BALF smear showed large amount of mycelium,which were cultured and identified as Aspergillus.All of the 4 patients were given antifungal therapy,3 patients were clinically improved,and 1 patient died.CONCLUSIONThe illness condition of the ABPA patients complicated with IPA is relatively complex and serious,the GM test of BALF is conducive to the early diagnosis,and it is necessary to take comprehensive measures on the basis of sensitive antifungal drug therapy so as to improve the prognosis of the patients.