CAJ | 학술논문

目的探讨变应性支气管肺曲霉病(ABPA)治疗中可能的复发原因.方法回顾性分析郑州大学第一附属医院呼吸内科2011年8月至2012年8月确诊ABPA的8例患者的临床资料.结果8例患者中男5例,女3例,住院期间给予静脉应用或口服糖皮质激素(简称激素),同时据胸部CT渗出影范围大小应用不同剂型伊曲康唑治疗.其中5例规律门诊随访,1例于出院6周后病情反复再次入院；3例未规律随诊,于出院后2～3个月再次入院.对比未出现病情反复患者(A组)及病情反复患者(B组)的临床资料,分析B组再入院的原因.A组于随诊期间遵医嘱规律减用强的松片[起始剂量0.5 mg/(kg·d)],同时口服伊曲康唑口服液.B组中1例规律随诊,因工作中接触霉菌于出院后6周再入院；1例因激素不良反应自行停用强的松片,1例自行于1个月内将强的松快速减量至停用,二者均继续服用伊曲康唑；1例口服伊曲康唑1个月自行停药.结论对于ABPA患者,应用激素后症状迅速缓解,联合抗真菌治疗能取得较好疗效,单用任意一种治疗均可增加病情复发风险.激素的突然停用及不按疗程服用是病情反复的最大因素,即使抗真菌治疗也不能扭转反复趋势,激素的正确应用是治疗ABPA的基础.治疗中处于高浓度曲霉环境也是病情反复的一个重要因素.
목적 탐토변응성지기관폐곡매병(ABPA)치료중가능적복발원인.방법 회고성분석정주대학제일부속의원호흡내과2011년8월지2012년8월학진ABPA적8례환자적림상자료.결과8례환자중남5례,녀3례,주원기간급여정맥응용혹구복당피질격소(간칭격소),동시거흉부CT삼출영범위대소응용불동제형이곡강서치료.기중5례규률문진수방,1례우출원6주후병정반복재차입원；3례미규률수진,우출원후2～3개월재차입원.대비미출현병정반복환자(A조)급병정반복환자(B조)적림상자료,분석B조재입원적원인.A조우수진기간준의촉규률감용강적송편[기시제량0.5 mg/(kg·d)],동시구복이곡강서구복액.B조중1례규률수진,인공작중접촉매균우출원후6주재입원；1례인격소불량반응자행정용강적송편,1례자행우1개월내장강적송쾌속감량지정용,이자균계속복용이곡강서；1례구복이곡강서1개월자행정약.결론 대우ABPA환자,응용격소후증상신속완해,연합항진균치료능취득교호료효,단용임의일충치료균가증가병정복발풍험.격소적돌연정용급불안료정복용시병정반복적최대인소,즉사항진균치료야불능뉴전반복추세,격소적정학응용시치료ABPA적기출.치료중처우고농도곡매배경야시병정반복적일개중요인소.
Objective To study the recurrence cause of allergic bronchopulmonary aspergillosis (ABPA) during the treatment.Methods The clinical data of 8 patients with ABPA in the first affiliated hospital of Zhengzhou university from August 2011 to August 2012 were retrospectively analyzed.Results There were 5 males and 3 female.All of them were given glucocorticoids and itraconazole.Five patients were regularly followed,and one of them recurrented after six weeks.Three patients weren' t follow-up recurrented after 2 to 3 months.Patients gained good effect (group A) and recurrent patients (group B) was compared,then the recurrence causes of group B was analyzed.Patients in group A in the follow-up period were given reduced dose of prednisione [initial dose was 0.5 mg/(kg · d)],and were given itraconazole at the same time.In group B,1 case regularly follow-up readmission in 6 months for contact mould on work.One case disabled prednisone for the side effects,one patient reduced the prednisone and disabled in 1 mnonth,both continued to take itraconazole.One patient stopped using itraconazole after 1 month.Conclusions Patients of ABPA will be rapidly relieved after using glucocorticoids,combined with antifungal treatment obtain a good therapeutic effect,only use one of them may increase the risk of recurrence.Discontinuation suddenly and erratic application of the glucocorticoids are important factors of recurrence,even if the antifungal treatment can' t change it,the correct application of glucocorticoids is the foundation for patients with ABPA.Also a high concentration aspergillus environment is an important factor for the recurrence of ABPA.