不同剂量口服糖皮质激素联合伏立康唑治疗变应性支气管肺曲霉病的疗效分析

Effect of different doses of oral glucocorticoid combined with voriconazole on treatment of allergic bronchopulmonary aspergillosis

目的分析不同剂量口服糖皮质激素联合伏立康唑治疗变应性支气管肺曲霉病(ABPA)患者的临床特点及疗效,为治疗提供参考。方法回顾分析2014年1月1日-2018年1月1日医院呼吸与危重症医学科确诊为ABPA且接受口服糖皮质激素联合伏立康唑治疗的32例患者一般资料,分析患者治疗前后临床表现、实验室检查结果、影像资料及随访情况。结果 32例ABPA患者均为支气管扩张型-ABPA患者;17例接受口服中剂量泼尼松(0.5mg/kg.d)初始治疗,15例接受小剂量口服泼尼松(0.25mg/kg.d);两组患者于血清总IgE降幅,症状改善及肺功能改善无差异;但是中剂量组接受了更多糖皮质激素治疗且激素副反应发生率高于小剂量组。结论ABPA活动期给予更小剂量口服糖皮质激素联合伏立康唑治疗同样有效且糖皮质激素副反应发生率更低。

OBJECTIVE To summarize the clinical characteristics and curative effect of different doses of oral glucocorticoid combined with voriconazole on treatment of patients with allergic bronchopulmonary aspergillosis（ABPA）so as to provide guidance for clinical treatment.METHODS The baseline data of 32 patients who were diagnosed with ABPA in respiratory and critical medical department and treated with oral glucocorticoid combined with voriconazole from Jan 1,2014 to Jan 1,2018 were retrospectively analyzed.The clinical manifestations,results of laboratory examinations,imaging data and follow-up visits were observed before and after the treatment.RESULTS All of the 32 ABPA patients were diagnosed with tracheal dilatation type of ABPA,17 patients received oral administration of medium-dose prednisolone（0.5 mg/kg.d）for initial treatment,and 15 patients received small-dose of prednisone（0.25 mg/kg.d）.There was no significant difference in reduction of serum total IgE,improvement of symptoms or improvement of lung function between the two groups of patients,however,the incidence of hormone-induced adverse reactions of the medium-dose group was higher than that of the small-dose group due to the use of higher dose of glucocorticoid.CONCLUSION The lower dose of oral glucocorticoid combined with voriconazole is still effective for treatment of active stage ABPA,and the incidence of glucocorticoid-induced adverse reactions is lower.