儿童变应性支气管肺曲霉病的诊治要点

Key Points of Diagnosis and Treatment in Children with Allergic Bronchopulmonary Aspergillosis

变应性支气管肺曲霉病(ABPA)是烟曲霉致敏引起的一种变应性肺部疾病,好发于哮喘或囊性纤维化患者,表现为慢性咳喘发作和反复出现的肺部浸润影,可伴有支气管扩张,诊断需要结合曲霉致敏的特殊实验室检查及影像学表现。中国儿童ABPA病例较少,易被漏诊、误诊。目前ABPA主要治疗药物是糖皮质激素,抗真菌药物辅助治疗,以减轻肺部炎症、控制哮喘、治疗急性期ABPA、防止ABPA加重、缓解支气管扩张和慢性肺曲霉病的发生或进展。早期识别儿童ABPA,规范治疗及合理应用激素和抗真菌药物可改善预后。

Allergic bronchopulmonary aspergillosis（ABPA） is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus,to which patients with asthma and cystic fibrosis are susceptible,manifesting with poorly controlled cough and asthma,recurrent pulmonary infiltrates and bronchiectasis. The diagnosis depends on special laboratory examinations proving hypersensitivity to Aspergillus fumigatus and imaging features. There are few Chinese ABPA children,which may easily cause missed diagnosis or misdiagnosis. At present,the main treatment is glucocorticoid. Antifungal drug is adjuvant therapy,aimed to alleviate pulmonary inflammation,control asthma,treat acute ABPA,prevent exacerbation,alleviate occurrence and progression to bronchiectasis and chronic pulmonary aspergillosis. Early identification,standard treatment and rational use of glucocorticoid and anti-fungal agents lead to good prognosis.