变应性支气管肺曲霉病13例临床分析

A clinical analysis of 13 cases of allergic bronchopulmonary aspergillosis

目的通过对变应性支气管肺曲霉病(ABPA)的临床分析来提高对该病的诊治认识。方法收集确诊的13例ABPA患者的临床资料,对其临床表现、实验室检查、影像学特点、治疗方法进行回顾性分析。结果13例患者临床表现均缺乏特异性,主要表现有咳嗽、咳痰、气促、发热、咯血;确诊前误诊为支气管扩张4例、肺癌4例、单纯哮喘2例、肺炎1例、弥漫性泛细支气管炎1例、急性嗜酸性粒细胞性肺炎1例。实验室检查13例患者的血清总IgE均升高,中位数为3320 U/mL。曲霉特异性IgE升高,中位数为13.2 kUA/L。外周血嗜酸性粒细胞升高,中位数为1×109·L-1。胸部CT改变主要有中心性支气管扩张7例、支气管黏液栓6例、斑片浸润影4例。13例患者中3例经口服糖皮质激素联合抗真菌药物治疗后好转,10例经口服糖皮质激素治疗后好转。结论ABPA发病率低,临床表现无特异性,易导致误诊、漏诊。在临床上对于可疑患者应及时完善血清总IgE、曲霉特异性IgE、外周血嗜酸性粒细胞、曲霉皮肤点刺试验、胸部高分辨CT等检查,尽早明确诊断。口服糖皮质激素联合抗真菌药物治疗证实有效,可缓解临床症状,减少复发,改善预后。

Objective To analysis and summarize the clinical data of allergic bronchopulmonary aspergillosis in order to improve the level of its diagnosis and treatment.Methods Thirteen patients of allergic bronchopulmonary aspergillosis were collected.Their clinical manifestation,laboratory examination,imaging characteristics and treatment were retrospectively analyzed.Results Thirteen cases of ABPA were collected.The clinical manifestations of 13 patients were lack of specificity.Common symptoms were cough,expectoration,wheeze,fever and hemoptysis.They were misdiagnosed as bronchiectasis in 4 cases,lung cancer in 4 cases,asthma in 2 cases,pneumonia in 1 case,diffuse panbronchiolitis(DPB)in 1 case,acute eosinophilic pneumonia(AEP)in 1 case before they diagnosed as ABPA.The laboratory examination showed all cases had increased total serum IgE levels(median 3320 U/mL),serum IgE antibodies specific to A.fumigatus(median 13.2 KU/L)and peripheral blood eosinophil count(median 1×109/L).The main manifestations on chest CT were central bronchiectasis(7 cases),finger-in-glove opacities(6 cases),and patch infiltrations(4 cases).There were 3 of the 13 patients were treated with eorticosteroids combined with antifungal therapy,and 10 of them were treated with eorticosteroids.All their condition all had been improved.Conclusion ABPA is rare,with no specific clinical manifestations,which may lead to misdiagnosis and missed diagnosis.In clinic,the total serum IgE,sIgE,peripheral blood eosinophil count,Aspergillus skin test and chest HRCT are helpful for definite diagnosis.Oral eorticosteroids combined with antifungal drugs were proved effective in relieving clinical symptoms,reducing recurrence and improving prognosis.