生物制剂治疗变应性支气管肺曲霉菌病的研究进展

Biological agents in the treatment of allergic bronchopulmonary aspergillosis

变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis, ABPA)是曲霉菌致敏引起的一种变应性肺部疾病,好发于支气管哮喘和囊性纤维化(cystic fibrosis, CF)患者,其治疗目标为控制炎症、减少急性加重次数、防止或减轻肺损伤,糖皮质激素和抗真菌药物是其主要治疗药物。但长期应用糖皮质激素可诱发或加重感染、消化道溃疡及出血、骨质疏松和电解质紊乱等不良反应,且并非所有患者对糖皮质激素、抗真菌药物反应良好。生物制剂可明显缓解ABPA患者的临床症状,降低炎症标志物如嗜酸性粒细胞计数、血清IgE水平,减少急性加重次数,改善肺功能。本文就ABPA的发病机制、治疗措施及生物制剂应用的研究进展作一综述。

Allergic bronchopulmonary aspergillosis(ABPA) is an allergic lung disease caused by Aspergillus sensitization, generally occurring in patients with bronchial asthma and cystic fibrosis. The treatment goal is to control inflammation, reduce the frequency of acute exacerbations, and prevent or reduce lung injury. Glucocorticoid and antifungal drugs are the main therapeutic drugs. However, long-term use of glucocorticoid would cause even aggravate the adverse reactions, such as infections, peptic ulcers and bleeding, osteoporosis and electrolyte disturbances, and not all patients can respond well to glucocorticoid and antifungal drugs. Biological agents can significantly relieve the clinical symptoms of ABPA patients, reduce the levels of inflammatory markers as eosinophil count and serum IgE, reduce the frequency of acute exacerbations and improve lung function. This paper reviews the research progress of the pathogenesis, therapeutic measures, and application of biological agents in the treatment of ABPA.