CAJ | 학술논문

变应性支气管肺曲菌病(allergic bronchopulmonary aspergillosis,ABPA)是机体对烟曲霉过敏引起的一种免疫性肺部疾病,最常见于哮喘和囊性纤维化患者.诊断标准包括慢性哮喘的临床表现、反复肺浸润与支气管扩张、血嗜酸粒细胞增高、血清总IgE增高及烟曲霉皮肤试验阳性等.由于许多ABPA患者症状轻微或无症状,对于哮喘患者一定要想到ABPA的可能,并进一步筛查皮肤试验,以防漏诊.早期诊断可早期给予糖皮质激素治疗,但激素可能要长期应用,激素联合较新的唑类抗真菌药可能更有效.本文对近几年来ABPA的流行病学、发病机制、诊断及处理进行综述.
변응성지기관폐곡균병(allergic bronchopulmonary aspergillosis,ABPA)시궤체대연곡매과민인기적일충면역성폐부질병,최상견우효천화낭성섬유화환자.진단표준포괄만성효천적림상표현、반복폐침윤여지기관확장、혈기산립세포증고、혈청총IgE증고급연곡매피부시험양성등.유우허다ABPA환자증상경미혹무증상,대우효천환자일정요상도ABPA적가능,병진일보사사피부시험,이방루진.조기진단가조기급여당피질격소치료,단격소가능요장기응용,격소연합교신적서류항진균약가능경유효.본문대근궤년래ABPA적류행병학、발병궤제、진단급처리진행종술.
Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus,most often occurring in a patient with asthma or cystic fibrosis.Diagnostic criteria include clinica manifestations of chronic asthma,recurrent pulmonary infiltrates with bronchiectasis,serum eosinophilia,elevated serum total IgE and Aspergillus fumigatus skin test positive,etc.Because many patients with ABPA may be minimally symptomatic or asymptomatic,a high index of suspicion for ABPA should be maintained while managing any patient with asthma,and further screening Aspergillus fumigatus by skin testing to prevent misdiagnosis.Early recognition allows treatment with corticosteroids,which are effective but may be required indefinitely,and combined hormone with newer antifungal azoles may be more effective.This review summarizes the advances in the diagnosis and management of ABPA.