变应性支气管肺曲霉病临床特点及基础疾病分析

Analysis of clinical features and underlying diseases of allergic bronchopulmonary aspergillosis

目的探讨基础疾病对变应性支气管肺曲霉病(ABPA)临床特征的影响。方法回顾性分析北京大学人民医院2010年1月至2019年9月确诊的ABPA住院患者的临床资料,比较基础疾病不同的患者临床特征有无差异。结果共纳入40例患者,无明确支气管哮喘(简称哮喘)病史者共8例(20.0%),以慢性阻塞性肺疾病(简称慢阻肺)、支气管扩张为主,无明确哮喘病史者病程较短[78(6~300)个月比192(39~480)个月,P=0.02],外周血中性粒细胞百分比(79.9%±12.5%比68.1%±18.1%,P=0.01)及肺气肿范围评分[2(0~2)比0(0~1),P=0.02]高于合并哮喘的ABPA患者。结论无明确哮喘病史的ABPA患者临床及影像特征与合并哮喘的ABPA患者无显著差异,慢阻肺、支气管扩张等肺部疾病患者出现喘憋加重,血嗜酸性粒细胞增多、黏液栓塞等特征时也应考虑ABPA的诊断。

Objective Allergic bronchopulmonary aspergillosis(ABPA) is characterized by an exaggerated reaction to airway colonization aspergillus which affects patients with underlying diseases such as bronchial asthma, cystic fibrosis or other respiratory diseases. ABPA exhibit significant heterogeneity due to the underlying diseases. The clinical features of patients with ABPA were analyzed retrospectively, so as to explore the impact of underlying diseases on clinical characteristics. Methods The clinical data of hospitalized patients diagnosed with ABPA from January 2010 to September 2019 in Peking University People’s Hospital were reviewed for retrospective analysis. Results A total of 40 ABPA patients were enrolled. Of which 8 cases(20.0%) were previously diagnosed as chronic obstructive pulmonary disease and/or bronchiectasis, named non-asthma group;while the other 32 cases met the diagnosis criteria of asthma,named asthma group. The non-asthma ABPA patients had a shorter course [78(6-300) months vs. 192(39-480)months, P=0.02], a higher percentage of peripheral blood neutrophils(79.9%±12.5% vs. 68.1%±18.1%, P=0.01) and higher score of emphysema [2(0-2) vs. 0(0-1), P=0.02] than the asthma group. Conclusions There is no significant difference in clinical and radiological characteristics between ABPA patients without asthma and those with asthma. The diagnosis of ABPA should also be considered when patients with chronic pulmonary diseases such as chronic obstructive pulmonary disease and bronchiectasis have aggravation of dyspnea, increase of eosinophils in peripheral blood and typical imaging features such as mucus attenuation.