支气管哮喘合并变应性支气管肺曲霉病29例临床特征

Clinical Features of 29 Cases of Bronchial Asthma Complicated with Allergic Bronchopulmonary Aspergillosis

目的探讨支气管哮喘合并变应性支气管肺曲霉病(ABPA)的临床特征。方法收集2016年4月至2019年7月在郑州大学第一附属医院收治的29例支气管哮喘合并ABPA的患者,分析其临床表现、外周血嗜酸性粒细胞水平(EOS)、癌胚抗原(CEA)、C反应蛋白(CRP)、动脉血二氧化碳分压(PaCO 2)、动脉血氧分压(PaO 2)、动脉血乳酸水平(Lac)、1,3-β-D葡聚糖检测(G试验)、半乳甘露聚糖检测(GM试验)、第1秒用力呼气容积与用力肺活量比值(FEV 1/FVC)、第1秒用力呼气容积占预计值百分比(FEV 1/预计值)、变应原烟曲霉水平、总IgE水平、CT表现以及治疗情况等。结果支气管哮喘合并ABPA患者共29例,男13例,女16例,年龄(48.31±13.72)岁。常见的症状包括胸闷气喘(75.86%)、咳嗽(68.97%)、咳痰(44.83%)、发热(33.33%);19例(65.52%)患者的EOS升高,22例(75.86%)患者变应原烟曲霉>0.34 kUA·L^(-1),19例(65.52%)总IgE>1000 kU·L^(-1);所有患者均行肺功能检查及胸部CT检查,其中19例(65.52%)患者出现阻塞性通气功能障碍,15例(51.90%)患者出现弥散性功能障碍;22例(75.86%)患者胸部CT表现为双侧肺支气管扩张,9例(31.03%)出现纵隔淋巴结增大。变应原烟曲霉及纵隔淋巴结增大与血清总IgE水平均存在正相关性(P<0.05)。结论支气管哮喘患者反复胸闷、气喘等症状控制不佳,胸部CT出现支气管扩张或胸膜增厚、淋巴结增大时应警惕ABPA的可能,临床遇见出现上述症状和体征的患者应常规监测EOS以及变应原烟曲霉水平,以排除ABPA。

Objective To investigate the clinical features of bronchial asthma complicated with allergic bronchopulmonary aspergillosis.Methods A total of 29 patients with bronchial asthma combined with ABPA admitted to the First Affiliated Hospital of Zhengzhou University from April of 2016 to July of 2019 were collected.The clinical manifestations,peripheral blood eosinophils(EOS),carcinoembryonic antigen(CEA),C-reactive protein(CRP),partial pressure of carbon dioxide in arterial blood(PaCO 2),partial pressure of oxygen in arterial blood(PaO 2),arterial blood lactic acid(Lac),1,3-β-D glucan detection test(G-test),galactomannan(GM-test),the first second forced expiratory volume and forced vital capacity ratio(FEV 1/FVC),percentage of forced expiratory volume in the first seconds of expected value(FEV 1/expected value),aspergillus allergen smoke level,total IgE level,CT manifestations and treatment were analyzed.Results There were 29 patients with bronchial asthma complicated with ABPA,including 13 males and 16 females,aged(48.31±13.72)years.Common symptoms included chest tightness and asthma(75.86%),cough(68.97%),expectoration(44.83%)and fever(33.33%).EOS increased in 19 patients(65.52%),allergic to aspergillus fumigatus>0.34 kUA·L^(-1) in 22 patients(75.86%)and total IGE>1000 kU·L^(-1) in 19 patients(65.52%).All patients underwent pulmonary function examination and chest CT examination,among which 19 patients(65.52%)had obstructive ventilation dysfunction and 15 patients(51.90%)had diffuse dysfunction.Twenty-two patients(75.86%)showed bilateral bronchiectasis on chest CT,and 9 patients(31.03%)showed enlarged mediastinal lymph nodes.The allergen aspergillus fumigatus and mediastinal lymph node enlargement were positively correlated with serum total IgE level(P<0.05).Conclusion Bronchial asthma patients with repeated chest tightness,asthma and other symptoms are not well controlled.Chest CT shows bronchiectasis or pleural thickening,lymph node enlargement,and it should be alert to the possibility of ABPA.It is necessary to exclude ABPA by peripheral blood eosinophil level and allergen aspergillus fumigatus level when patients met such symptoms.