CAJ | 학술논문

目的观察支气管哮喘(简称哮喘)患者中曲霉过敏试验阳性的比例、变应性支气管肺曲霉病(ABPA)的检出比例及ABPA患者的临床及影像学特点.方法选取2010年3-9月在北京大学人民医院门诊就诊的非吸烟成年(≥18岁)哮喘患者200例,行过敏原皮肤点刺试验,血嗜酸粒细胞计数、血清总IgE测定、血清抗烟曲霉、抗多价霉菌特异性IgE测定及影像学检查、肺通气功能测定.结果 200例患者中烟曲霉皮肤点刺试验阳性者共11例(5.5％),其中5例患者诊断为ABPA,男2例,女3例,年龄为19 ～62岁,病程为15 ～40年.临床上均有咳嗽、喘息等典型哮喘症状,其中4例患者肺功能显著下降,血清总IgE及烟曲霉特异性lgE均明显升高,3例患者血嗜酸粒细胞升高,3例患者胸部CT可见中心性支气管扩张.结论我国ABPA的患病率长期被低估,ABPA患者临床表现与单纯的哮喘难以区分,但病程长,肺功能下降更显著.烟曲霉过敏原皮试和血清总IgE是诊断本病的重要提示指标.
목적 관찰지기관효천(간칭효천)환자중곡매과민시험양성적비례、변응성지기관폐곡매병(ABPA)적검출비례급ABPA환자적림상급영상학특점.방법 선취2010년3-9월재북경대학인민의원문진취진적비흡연성년(≥18세)효천환자200례,행과민원피부점자시험,혈기산립세포계수、혈청총IgE측정、혈청항연곡매、항다개매균특이성IgE측정급영상학검사、폐통기공능측정.결과 200례환자중연곡매피부점자시험양성자공11례(5.5％),기중5례환자진단위ABPA,남2례,녀3례,년령위19 ～62세,병정위15 ～40년.림상상균유해수、천식등전형효천증상,기중4례환자폐공능현저하강,혈청총IgE급연곡매특이성lgE균명현승고,3례환자혈기산립세포승고,3례환자흉부CT가견중심성지기관확장.결론 아국ABPA적환병솔장기피저고,ABPA환자림상표현여단순적효천난이구분,단병정장,폐공능하강경현저.연곡매과민원피시화혈청총IgE시진단본병적중요제시지표.
Objective To evaluate the frequency of sensitization to Aspergillus antigens and the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients.Methods Two hundred consecutive non-smoking outpatients with asthma (≥ 18 years) underwent skin testing with aeroallergens,peripheral eosinophil counting,measurements of total serum IgE level and specific IgE against Aspergillus fumigatus,radiologic investigations and pulmonary function tests.Results Eleven patients (5.5％) had a positive skin reactivity to Aspergillus antigens.Five of these 11 patients (45.5％ ) met the diagnostic criteria of ABPA,an overall prevalence of 2.5％ ( 5/200 ).There were 2 males and 3 females,aging from 19 to 62 years,with a disease duration from 15 to 40 years.All of the patients had asthmatic symptoms such as cough and wheeze.Moderate to severe obstructive ventilatory defect was found in 4 patients.Total serum IgE levels and specific lgE against Aspergillus fumigates were elevated significantly in all the patients,and elevated eosinophil count was found in 3 patients.Three cases were diagnosed as ABPA-CB because of the presence of central bronehiectasis on HRCT.Conclusions The prevalence of ABPA in Chinese patients with asthma was underestimated.Clinical features of ABPA were similar to asthma alone,but with longer duration and more severe lung function defect.Sensitization to Aspergillus,increased eosinophils and total serum IgE levels were important indicators for the diagnosis of ABPA.