CAJ | 학술논문

目的探讨变应性支气管肺曲霉病( ABPA)的临床特征、影像学特点、诊断和治疗方法,以做到早期诊断及早期治疗.方法回顾性分析解放军总医院2010年3月至2011年5月确诊的7例ABPA患者的临床资料.结果 7例中,男4例,女3例,平均年龄为(33±16)岁.在确诊ABPA前,曾被误诊为支气管哮喘(简称哮喘)6例,肺部感染3例,肺结核2例,支气管扩张1例.主要临床表现为咳嗽6例,咳痰5例,咯血4例(其中3例为黑褐色痰),喘息3例,气短3例,发热2例.7例外周血中总IgE均升高,中位数为3040 U/ml.7例外周血中嗜酸粒细胞比均升高,中位数为0.19.6例外周血中嗜酸粒细胞绝对值升高,中位数为1.84×109/L；6例曲霉皮肤点刺试验阳性；5例血清特异性烟曲霉IgE抗体升高,平均为(22±15) kU/L；4例血清特异性烟曲霉IgG抗体升高,平均为(108±96) mg,/L.胸部CT主要表现为双肺多发性斑片状影、中心型支气管扩张及支气管黏液栓形成.5例患者接受口服糖皮质激素(简称激素)联合抗真菌药物治疗.结论 ABPA主要临床特点为常有哮喘病史,胸部影像学显示游走性或固定性肺部浸润影或中心型支气管扩张,外周血中嗜酸粒细胞、血清总IgE水平和血清烟曲霉特异性IgE抗体均升高.对哮喘合并支气管扩张的患者应高度警惕ABPA的可能,应常规进行曲霉皮肤试验筛查,必要时行外周血总IgE及胸部CT检查,以提高ABPA的诊断率.口服激素联合抗真菌药物对ABPA治疗有效.对ABPA患者应注意规律随诊并监测病情的变化,防止病情复发加重.
목적 탐토변응성지기관폐곡매병( ABPA)적림상특정、영상학특점、진단화치료방법,이주도조기진단급조기치료.방법 회고성분석해방군총의원2010년3월지2011년5월학진적7례ABPA환자적림상자료.결과 7례중,남4례,녀3례,평균년령위(33±16)세.재학진ABPA전,증피오진위지기관효천(간칭효천)6례,폐부감염3례,폐결핵2례,지기관확장1례.주요림상표현위해수6례,해담5례,각혈4례(기중3례위흑갈색담),천식3례,기단3례,발열2례.7예외주혈중총IgE균승고,중위수위3040 U/ml.7예외주혈중기산립세포비균승고,중위수위0.19.6예외주혈중기산립세포절대치승고,중위수위1.84×109/L；6례곡매피부점자시험양성；5례혈청특이성연곡매IgE항체승고,평균위(22±15) kU/L；4례혈청특이성연곡매IgG항체승고,평균위(108±96) mg,/L.흉부CT주요표현위쌍폐다발성반편상영、중심형지기관확장급지기관점액전형성.5례환자접수구복당피질격소(간칭격소)연합항진균약물치료.결론 ABPA주요림상특점위상유효천병사,흉부영상학현시유주성혹고정성폐부침윤영혹중심형지기관확장,외주혈중기산립세포、혈청총IgE수평화혈청연곡매특이성IgE항체균승고.대효천합병지기관확장적환자응고도경척ABPA적가능,응상규진행곡매피부시험사사,필요시행외주혈총IgE급흉부CT검사,이제고ABPA적진단솔.구복격소연합항진균약물대ABPA치료유효.대ABPA환자응주의규률수진병감측병정적변화,방지병정복발가중.
Objective To study the clinical features,diagnosis and treatment of allergic bronchopulmonary aspergillosis (ABPA).Methods The clinical presentations,serologic results,chest radiology,pathological results and treatment of 7 patients with ABPA in Chinese PLA General Hospital were retrospectively analyzed.Results There were 4 males and 3 females,with a mean age of (33 ± 16) years.Before the diagnosis of ABPA,6 cases had been misdiagnosed as bronchial asthma,3 as pulmonary infection,2 as tuberculosis and 1 as bronchiectasis.The main clinical manifestations included cough (n =6),sputum production (n =5),hemoptysis (n =4),wheeze (n=3),dyspnea(n =3) and fever(n =2).All cases had increased total serum IgE levels (median 3040 U/ml) and peripheral blood eosinophil count (median 0.19).Six of them showed increased peripheral eosinophil count median 1.84 × 109/L,and skin test positive for Aspergillus antigen.Five of them had increased serum IgE antibodies specific to A.fumigatus (22 ± 15 ) kU/L,and 4 had increased serum IgG antibodies specific to A.fumigatus (108 ± 96) mg/L.The chest CT scan findings included transient or fixed pulmonary opacities,central bronchiectasis and fingerin-glove opacities. Five patients were treated with corticosteroids combined with antifungal therapy.Conclusions Clinical features of ABPA include a history of asthma,elevation of the total serum IgE levels,presence of aspergillus IgE antibodies,peripheral eosinophilia,and transient or fixed pulmonary opacities and central bronchiectasis.Patients with asthma complicated with bronchiectasis should be routinely screened for Aspergillus skin test,and measurement of total serum IgE levels and chest CT scan are uséful for confirmation of the diagnosis of ABPA.Oral glucocorticoids and anti-fungal drugs are effective in treatment of ABPA.Regular follow-up is needed for prevention of recurrence.