5例变应性支气管肺曲菌病长期误诊临床分析

变应性支气管肺曲菌病(ABPA)是人体对曲霉菌(主要是烟曲霉)产生超敏反应引起的一种疾病.因该病较为少见、临床医师对其认识不足、大多医院缺少烟曲霉特异性检查手段等因素,病人往往被长期误诊误治,严重影响患者预后.本文将对江苏省人民医院呼吸科5例确诊ABPA患者进行临床分析,以提高对该病的认识,减少误诊.     

变应性支气管肺曲霉菌病不同影像分型的临床特征

目的:分析变应性支气管肺曲霉菌病(ABPA)不同影像分型患者的临床表现、血清学、肺功能等特点,提高ABPA早期诊断与治疗。方法:对2006年1月至2020年6月中国医科大学附属盛京医院确诊的影像学不同分型的ABPA患者的临床、血清学、肺功能等资料进行回顾性分析比较。结果:44例影像学不同分型的ABPA患者主要临床表现为...     

变应性支气管肺曲霉病七例临床特点分析

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.     

64排螺旋CT诊断变应性支气管肺曲霉菌病的价值

目的分析变应性支气管肺曲霉菌病(ABPA)的螺旋CT表现,提高对其诊断准确率。方法回顾性分析我院10例经临床确诊ABPA患者的螺旋CT影像资料,进行总结分析。结果中心性支气管扩张10例,扩张的支气管腔内粘液栓形成8例,其中5例粘液栓呈高密度,浸润性实变6例,树芽样影像表现4例。结论 ABPA的螺旋CT表现的主要特征为中心性支气管扩张,且在扩张的支气管管腔内可见粘液栓,部分为高密度粘液栓,此特征性CT表现结合患者临床症状及实验室检查结果基本可以确诊ABPA。     

变应性支气管肺曲霉病三例并文献复习

目的 探讨变应性支气管肺曲霉病(ABPA)的临床与影像学特点,提高早期诊断率.方法 通过中国生物医学文献光盘数据库(CBM-Disk)检索1991年1月至2008年3月有关报道ABPA的文献,剔除重复累计报道病例,结合本院收治的3例患者,回顾性分析我国ABPA的临床资料.结果 57例ABPA中,男33例,女24例,平均年龄(41±15)岁.主要临床表现:咳嗽51例,咳痰50例,喘息47例,气促44例,发热33例,咯血28例,咳痰栓史18例,胸痛13例,消瘦8例.外周血嗜酸粒细胞绝对值为(0.01～15.34)×10<'9>/L,中位值为2.46×10<'9>/L.外周血总IgE为349～13 000IU/ml.41例行肺功能检查,FEV<,1>%为(64±25)%,FEV<,1>/FVC%为(63±11)%.9例支气管舒张试验阳性,3例组胺激发试验阴性.33例行胸部高分辨率(HR)CT检查,斑片状渗出影32例,中心性支气管扩张25例,树杈样或条状影12例,结节影11例,实变影8例,纵隔淋巴结增大13例,病变游走24例.结论 我国ABPA少见,临床症状无特异性.对可疑患者应及早行外周血嗜酸细胞计数、血清IgE检测、曲霉皮肤试验及纤维支气管镜等检查.     

变应性支气管肺曲霉菌病32例临床分析

目的总结分析变应性支气管肺曲霉菌病(Allergic bronchopulmonary aspergillosis, ABPA)的临床表现、影像学,以探讨其临床特点,提高临床诊断水平,做到早期诊断和治疗。方法回顾性分析2011年9月至2019年11月南京鼓楼医院呼吸科收治ABPA患者的临床资料。结果 ABPA患者共32例,确诊ABPA之前误诊漏诊病例共22例(68.8%)。咳嗽(96.9%)、咳痰(93.8%)、喘息(56.3%)、咯血(25.0%);外周血嗜酸性粒细胞升高(72.7%);血清总IgE升高(63.0%);胸部HRCT可见病变为中心型支气管扩张(59.4%),黏液栓(15.6%);25例(78.1%)行糖皮质激素治疗,其中18例(56.3%)联合抗真菌药物,治疗8周后症状好转,随访半年病情稳定。结论 ABPA临床表现缺乏明显的特异性,患者咳嗽气喘伴外周血嗜酸性粒细胞数及血清总IgE升高、胸部HRCT特异性改变等,需考虑ABPA可能,支气管镜检查有助于诊断。     

呼出气一氧化氮检测在变应性支气管肺曲霉菌病诊疗中的应用

目的探讨呼出气一氧化氮(FeNO)检测在变应性支气管肺曲霉菌病(ABPA)诊疗中的应用,为ABPA的诊疗及管理提供新思路。方法收集2016年12月至2020年1月于河南省人民医院呼吸内科确诊的30例ABPA患者作为观察组;同期收集就诊于河南省人民医院呼吸内科非ABPA哮喘患者74例作为对照组,其中完善烟曲霉特异性血清免疫球蛋白E(IgE)及血清总IgE者41例。回顾性分析2组患者临床资料。结果2组患者年龄、性别及病程相比较,差异无统计学意义。观察组患者烟曲霉特异性IgE、血清总IgE、血嗜酸粒细胞计数、FeNO均高于对照组(t值分别为4.049、8.077、2.051、2.894,P值均<0.05)。spearman相关系数分析结果显示FeNO与ABPA具有一定相关性(r=-0346,P<005)。结论FeNO与ABPA的诊断具有一定的相关性,可为ABPA患者诊疗提供帮助。     

老年变应性支气管肺曲霉菌病CT影像征象分析

目的分析老年变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis, ABPA)CT影像征象,提高对老年ABPA的诊断水平。方法回顾性分析,经临床确诊的53例ABPA患者,分析31例老年ABPA患者的一般资料及CT影像特征;同时与中青年组ABPA患者进行对照分析,最终发现老年ABPA最具特征性的影像表现。结果 31例老年ABPA患者中,男19例(61.3%),发生在双肺上叶22例(71.0%),右肺下叶7例(22.6%);ABPA呈团块及结节状16例(51.6%),指套征7例(22.6%),牙膏状2例(6.5%);ABPA粘液栓呈中等密度16例(51.6%),高密度10例(32.3%);病灶远端支气管扩张9例(29.0%),病灶旁支气管扩张7例(22.6%);ABPA周围斑片影19例(61.3%),结节影及树芽征14例(45.2%),局限性肺气肿10例(32.3%),马赛克征7例(22.6%)。老年组与中青年组患者比较,ABPA呈团块及结节状、牙膏状、高密度粘液栓、病灶周围斑片影、病灶周围局限性肺气肿5项指标P0.05,差异有统计学意义。结论老年ABPA常发生在双肺上叶,病变呈团块及结节状、高密度粘液栓、病灶周围出现斑片影及局限性肺气肿是其典型的特征性表现。     

变态反应性支气管肺曲霉菌病合并血癌胚抗原升高2例临床分析

变态反应性支气管肺曲霉菌病(ABPA)是由曲霉属真菌引起的变态反应,发病率不高,常发于既往有支气管哮喘、支气管扩张的患者.ABPA与肺癌不易鉴别,易导致误诊误治,耽误患者的最佳治疗时机.血癌胚抗原(CEA)是恶性肿瘤的标志物,ABPA患者合并血CEA升高时更易引起临床误诊.本文就ABPA合并血CEA升高患者2例在我院的...     

19例变态反应性支气管肺曲霉病临床分析

目的总结分析不同类型变态反应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis,ABPA）的临床特点，提高对ABPA的认识，做到早诊断早治疗。方法分析中山医院近5年确诊的19例ABPA患者的临床资料，分为变态反应性支气管肺曲菌病-血清IgE增高型组和变态反应性支气管肺曲菌病-中心支气管扩张型组，比较两组病人的临床症状和实验室特点。结果19例ABPA患者中男11例，女8例，在确诊前被误诊为肺结核的有8例，误诊为肺癌的有3例，其他诊断包括支气管哮喘、过敏性肺炎、Wegener肉芽肿等。两组病人在年龄、性别、症状等方面差别无统计学意义，但ABPA伴中心型支气管扩张组的嗜酸粒细胞和血清总IgE水平比血清IgE增高型的ABPA组升高（P〈0.01），而第一秒用力呼气容积占预计值百分比则降低（P〈0.01）。结论不伴中心型支气管扩张的ABPA可能是疾病的早期或侵袭性较弱的一种形式，为避免肺功能出现不可逆的改变，对气喘、肺部出现游走性浸润影、嗜酸性粒细胞及IgE升高者应进一步查肺CT、烟曲菌特异性IgE和烟曲菌抗原皮内试验，以及早确诊并治疗。     

变态反应性支气管肺曲霉菌病11例临床分析

目的分析变态反应性支气管肺曲霉菌病（ABPA）的临床与影像学特点,以提高认识,减少误诊。方法对我院确诊的11例ABPA患者的临床资料进行回顾性分析。结果11例确诊ABPA患者,年龄46-85岁,平均年龄（67±12）岁,男性5例,女性6例。主要临床表现为喘息11例,咳嗽、咯痰10例（其中咳痰栓者3例）,咯血2例。烟曲霉抗原皮内试验呈速发阳性反应11例（＋～＋＋＋＋）。血清总IgE（正常范围0～144μg／L）均升高,其中9例〉1000μg／L（1427～9362μg／L）。血清烟曲霉特异性IgE（正常值〈0．43μg／L,0级）均升高,为5．04～118．569g／L（2～4级）。外周血嗜酸粒细胞计数6例升高（绝对值为0．52×10^9～3．6×10^9／L,百分比为6．1％～29．7％）,5例正常。胸部高分辨率CT显示斑片状渗出影11例（其中游走性病灶10例）,中心性支气管扩张9例,其中4例具有典型的黏液嵌塞征。肺功能检查10例星阻塞性通气功能障碍,第1秒用力呼气量（FEV1）／用力肺活量为（57±11）％,FEV。占预计值％为（48±15）％,其中支气管舒张试验阳性5例。所有病例均曾诊断为难治性哮喘、慢性阻塞性肺疾病或支气管扩张症。10例确诊后给予全身糖皮质激素治疗,病情缓解。1例属病程晚期,死于呼吸衰竭。结论对于临床表现为“难治性哮喘”或“支气管扩张症”伴有发作性喘息的患者,应想到ABPA可能。胸部CT、血清总IgE检测、烟曲霉抗原皮内试验有助于明确诊断。     

A case of effective readministration of itraconazole for recurrent allergic bronchopulmonary aspergillosis]

A 67-year-old woman suffered from productive cough but not from bronchial asthma. Her peripheral blood showed eosinophilia, a high serum level of total immunoglobulin E (IgE), and elevated specific IgE and positive precipitating antibody against Aspergillus fumigatus. Her chest radiograph and computed tomography revealed infiltrative shadows but not central bronchiectasis. Fibreoptic bronchoscopy detected some mucous plugs which grew Aspergillus fumigatus on culture. We therefore made a diagnosis of allergic bronchopulmonary aspergillosis (ABPA). We treated her using only itraconazole. Her respiratory symptoms, eosinophilia, serum IgE level, and pulmonary infiltration gradually improved, but withdrawal of itraconazole exacerbated her respiratory symptom and laboratory data. Administration of itraconazole again resulted in improvement of her symptoms and laboratory data. We report a case of ABPA without bronchial asthma or central bronchiectasis and refer to our diagnostic rationale. Furthermore, we discuss the decrease of allergens by the eradication of Aspergillus fumigatus in the airway with itraconazole to reduce the allergic reaction and improve the clinical symptoms.     

变态反应性支气管肺曲菌病23例分析

目的总结分析变态反应性支气管肺曲菌病（ABPA）的临床特点,以提高对ABPA的认识,做到早诊断、早治疗。方法回顾性分析北京协和医院近20年确诊的ABPA患者的临床资料。结果ABPA患者23例,男11例,女12例,年龄（34．0±13．2）岁。确诊ABPA前曾被误诊为肺结核12例,肺炎3例,肺癌2例,Wegener肉芽肿1例。症状有咳嗽（23例）、咳痰（22例）、气喘（18例）、痰栓（16例）、发热（15例,其中高热4例）、咯血（12例）、胸背痛（8例）、消瘦（7例）。外周血嗜酸性粒细胞绝对值（0．18-15．34）×10^9／L,中位值1．43×10^9／L;嗜酸性粒细胞数为0．016～0．721,中位值0.148。外周血总IGE349～13000IU／ml,其中t〉5000IU／ml者7例,2500—5000IU／ml者6例,1000～2500IU／ml者5例。肺功能检查18例,第1秒钟用力呼气容积（FEV,）占预计值百分比为（54．7±24．1）％,（FEV1／用力呼气容积）×100％为（62．5±11．9）％,可逆试验阳性率56％。胸部CT检查22例,表现为斑片状渗出影21例,中心型支气管扩张17例,结节影9例,树权样或条状痰栓征象6例,实变5例,纵隔淋巴结增大11例;病变呈游走性17例。结论临床上ABPA极易误诊为肺结核,若患者有气喘表现,肺功能示阻塞性通气功能障碍,外周血嗜酸性粒细胞增加,胸片示肺部浸润影呈游走性,多有中心性支气管扩张,可进一步查总IgE、烟曲菌特异性IgE、烟曲菌过敏原皮试以确诊。     

Allergic bronchopulmonary aspergillosis. Apropos of 30 cases

Thirty cases of allergic bronchopulmonary aspergillosis (ABPA) were treated between 1967 and 1981. Developing in patients with a history of chronic asthma (28 of the 30 cases), the initial manifestations of ABPA developed after long periods (an average of 29 years after the onset of the asthma). Chest radiography demonstrated recurrent labile infiltrates in 28 cases, segmental or lobar atelectasis in 7, and proximal bronchiectasis in 16 cases. A circulating eosinophilia was a constant finding, but this varied with time. Immunologic investigations gave positive skin tests, 19 of the 30 patients only presenting a cutaneous reaction delayed until the 6th hour. Total IgE, determined in 18 cases, varied between 600 and 9400 IU/ml (RIST), with identification of specific IgE for Aspergillus in all cases, though to varying degrees. Serial measurements of total IgE levels showed co-existence of an acute progression of the affection and elevated total IgE in 3 cases, but no correlation was found between serum IgE levels and the severity or chronicity of the disease. Physiopathologic features included immediate and partially delayed hypersensitivity to Aspergillus fumigatus. The frequency of ABPA during the course of mucoviscidosis suggests, by analogy, that a local factor may exist which favorizes Aspergillus fumigatus proliferation in patients with ABPA alone.     

Induced sputum eosinophils and neutrophils and bronchiectasis severity in allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to the fungus Aspergillus fumigatus that may progress to bronchiectasis. The aim of the present study was to characterize airway inflammation in patients with clinically stable ABPA and asthma, and to correlate this with bronchiectasis severity. Subjects with ABPA and central bronchiectasis (ABPA-CB; n=16) and ABPA with serological evidence alone (ABPA-S; n=10) were studied. Comparison groups were A. fumigatus-sensitized asthma (n=19), non-A. fumigatus-sensitized asthma (n=15) and healthy controls (n=8). Hypertonic saline challenge, sputum induction and high-resolution computed tomography (HRCT) of the chest were performed. Sputum eosinophil numbers were markedly elevated in ABPA-CB (median 8.4%) compared to ABPA-S (2.4%), A. fumigatus-sensitized asthma (1.8%), asthma (1.8%) and controls (0.3%) (p<0.01); sputum eosinophil cationic protein levels were higher in ABPA-CB (median 13,706 ng.mL(-1)), compared to ABPA-S (1,633.5 ng.mL(-1)), A. fumigatus-sensitized asthma (1,550.7 ng.mL(-1)), asthma (309.2 ng.mL(-1)), and controls (110 ng.mL(-1)) (p<0.001). ABPA-CB also showed increased sputum neutrophil number (median 60.3%) compared to the other groups (controls 29.3%) (p=0.01). The severity of bronchiectasis on HRCT correlated with sputum neutrophil (r=0.6) and eosinophil number (r=0.5) but not serum immunoglobulin-E levels. In conclusion, clinically stable allergic bronchopulmonary aspergillosis with bronchiectasis is characterized by an intense heterogenous inflammatory infiltrate consisting of eosinophils and neutrophils, which correlates closely with the severity of bronchiectasis on high-resolution computed tomography. Sputum analysis may be useful in monitoring the course of allergic bronchopulmonary aspergillosis.     

变态反应性支气管肺曲霉病研究进展

变态反应性支气管肺曲霉病(allergic bronchopulmonary aspergillosis,ABPA)与烟曲霉引起的变态反应相关,常发生在哮喘和肺囊性纤维化患者中.ABPA可引起血清总IgE水平升高,外周血嗜酸粒细胞增多,肺浸润和中心性支气管扩张,严重者可导致肺纤维化等肺组织的不可逆破坏.故ABPA的早期明确诊断和及时治疗十分重要.本文将对近年来ABPA的发病机制、临床分期、诊断标准、辅助检查及治疗研究新进展进行介绍.     

A case of allergic bronchopulmonary aspergillosis with no history of bronchial asthma]

A 53-year-old male was admitted to our hospital because of an abnormal shadow in the left upper lung. Bronchofiberscopy revealed edematous mucosa and pus at the orifice of the left upper lobe bronchus. Pathological examination revealed bronchial inflammatory change with infiltration of eosinophils and also the existence of aspergillus in the pus. Mild eosinophilia and elevation of serum IgE level were observed in the peripheral blood, and serum precipitin against Aspergillus fumigatus was positive. Bronchogram showed central bronchiectasis, and the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was made. In cases of ABPA, bronchial asthma is usually present prior to presentation, but this patient had no history of asthma even though airway hyperresponsiveness to methacholine was confirmed.