奥马珠单抗治疗变应性支气管肺曲霉菌病的临床疗效分析

Clinical analysis of omalizumab in treatment of allergic bronchopulmonary aspergillosis

目的观察奥马珠单抗对变应性支气管肺曲霉病(ABPA)患者肺功能和生活质量的改善作用,以及分析临床疗效。方法收集我院2015年1月-2017年1月治疗的ABPA患者临床资料86例。对照组泼尼松0. 5mg/kg·d,连用2周,隔日0. 5mg/kg,4-6周后逐渐减量,伊曲康唑200mg口服,2次/d,疗程4-6个月;观察组在对照组基础上使用奥马珠单抗0. 016mg/kg·Ig E,每2周一次,疗程4-6个月。结果疗程结束后观察组嗜酸性粒细胞、总Ig E和烟曲霉特异性Ig E分别为3. 13±0. 74%、317. 82±104. 53 IU/m L和5. 43±1. 52 IU/m L,显著低于对照组的7. 15±2. 62%、668. 42±157. 28 IU/m L和11. 36±3. 27 IU/m L(P <0. 01)。治疗后观察组FEV1/FVC和FEV1/pred为68. 74±7. 25%和79. 64±8. 82%,显著高于对照组的58. 12±6. 13%和71. 52±8. 54%(P <0. 05)。治疗后观察组AQLQ评分为5. 62±1. 14分,显著高于对照组的4. 38±0. 72分(P <0. 05)。观察组临床治疗有效率为88. 64%(39/44),显著高于对照组的71. 43%(30/42)(P <0. 05)。结论奥马珠单抗可以显著改善ABPA患者肺功能,提高患者生活质量,临床疗效显著。

Objective To detect the clinical curative effect of omalizumab in treatment of allergic bronchopulmonary aspergillosis （ABPA）. Methods A total of 86 ABPA patients were enrolled in this study. The control group was given by prednisone （0.5mg/kgd for 2 weeks, 0.5mg/kg of the other day, 4-6 weeks later, reduced gradually） and itraconazole （200mg, 2 times /d） for 4-6 months treatment. The observation group was given omalizumab 0.016mg/kg IgE on the basis of the control group, once every 2 weeks. Results After treatment, the levels of eosinophil, total IgE and Aspergillus fumigatus specific IgE in the observation group were 3.13±0.74%, 317.82±104.53 IU/mL, and 5.43±1.52 IU/mL, which was significantly lower than 7.15±2.62%, 668.42±157.28 IU/mL, and 11.36±3.27 IU/mL in the control group （ P〈 0.01）. The value of FEV 1/FVC and FEV 1/ pred in the observation group were 68.74±7.25% and 79.64±8.82%, which was significantly higher than 58.12±6.13% and 71.52±8.54% in the control group （ P〈 0.05）. The AQLQ score in the observation group was 5.62±1.14, which was significantly higher than 4.38±0.72 in the control group （ P〈 0.05）. The clinical effective rate was 88.64%（39/44） in the observation group, which was significantly higher than 71.43% （30/42）in the control group （ P〈 0.05）. Conclusion Omalizumab can significantly improve lung function and quality of life of ABPA patients, with effectively clinical efficacy.