儿童变应性支气管肺曲霉菌病影像学研究进展

变应性支气管肺曲霉菌病（ABPA）为免疫介导肺部疾病。儿童ABPA发病率较低,且临床特征相比成人较不典型,导致诊断难度较大。高分辨率CT是ABPA的首选影像学检查方法;MRI近年也逐渐用于诊断ABPA。本文基于ABPA发病机制及临床表现对儿童ABPA肺部影像学研究新进展进行综述。     

变应性支气管肺曲霉菌病1例分析

变应性支气管肺曲霉菌病(ABPA)又叫过敏性支气管肺曲霉菌病,是由曲霉菌过敏原引起的超敏反应所致复杂的疾病,临床上常常被误诊为结核、支气管扩张及哮喘等,进而延误疾病诊断和治疗,给患者造成不必要的损失。而影像学表现特别是CT所见能为ABPA的诊断提供了大量帮助,影像特征性表现对疾病诊治有非常重要的意义。现对我院2011年3月收治确诊并具有完整资料的1例ABPA结合相关文献进行复习,旨在为提     

变应性支气管肺曲霉菌病误诊为支气管哮喘临床分析

目的分析变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis,ABPA)的临床特点及诊治方法,以减少误诊。方法对我院收治的误诊为支气管哮喘的ABPA 1例的临床资料进行回顾性分析,并复习相关文献。结果患者因发作性咳嗽、气喘5年,加重15 d入院。曾在外院按支气管哮喘治疗效果不理想。入我院后经肺功能检查及支气管舒张试验诊断为支气管哮喘急性发作,予相应治疗效果不佳。查血清Ig E 1910 U/ml,混合过敏原检测示对尘螨过敏,痰培养见曲霉菌,肺部高分辨率CT检查示中心性支气管扩张,结合临床表现确诊为ABPA。予伏立康唑联合糖皮质激素口服治疗3周后,症状明显好转,痰培养阴性。结论临床上对以哮喘发作样症状为主要表现但按哮喘治疗效果不佳者应高度警惕ABPA,血清Ig E检测、痰培养及影像学检查对其诊断有重要意义。     

变应性支气管肺曲霉菌病1例救治体会

1病历简介 患者女性,70岁.咳嗽、气促4年,反复加重5 d入院.体温36.7℃,脉搏86次/min,呼吸频率26次/min,血压110/70 mm Hg(1 mm Hg=0.133 kPa).意识清,唇甲发绀,呼吸频速,双肺可闻及哮鸣音和湿口罗音,心律齐,余未见异常.     

生物制剂治疗变应性支气管肺曲霉菌病的研究进展

变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis, ABPA)是曲霉菌致敏引起的一种变应性肺部疾病,好发于支气管哮喘和囊性纤维化(cystic fibrosis, CF)患者,其治疗目标为控制炎症、减少急性加重次数、防止或减轻肺损伤,糖皮质激素和抗真菌药物是其主要治疗药物。但长期应用糖皮质激素可诱发或加重感染、消化道溃疡及出血、骨质疏松和电解质紊乱等不良反应,且并非所有患者对糖皮质激素、抗真菌药物反应良好。生物制剂可明显缓解ABPA患者的临床症状,降低炎症标志物如嗜酸性粒细胞计数、血清IgE水平,减少急性加重次数,改善肺功能。本文就ABPA的发病机制、治疗措施及生物制剂应用的研究进展作一综述。     

免疫功能正常者肺曲霉菌病的影像学表现

目的 探讨免疫功能正常者肺曲霉菌病的影像学表现。方法 收集9例经组织病理学确诊的免疫功能正常的肺曲霉菌病患者,回顾性分析其临床资料、X线片和CT表现。结果 9例患者均有胸片资料,其中8例有CT资料,且均接受增强CT检查。胸片示单发病灶1例,多发病灶8例,主要表现为多发结节影及大片状实变影,实变影及结节周围模糊,部分结节内可见空洞影。CT表现:肺部大片实变4例,其中3例可见"支气管气相征",实变并肺部小叶间隔增厚1例;肺部多发结节4例,结节周围可见"晕征";多数结节影沿支气管血管束分布,3例结节内见空洞,部分空洞内可见细线状分隔。增强后片状实变影及结节影均有强化,平扫CT值平均为(32.94±2.93)HU,增强后CT值平均为(64.13±6.31)HU。9例患者中3例合并胸腔积液。结论 免疫功能正常者肺曲霉菌病影像学表现多种多样,但在部分患者可有一定的特殊表现。     

肺曲霉菌病的影像诊断

目的探讨肺曲霉菌病的影像学表现特征，为肺曲霉菌病的临床诊断提供诊断依据。方法收集我院近10年来有完整影像、细菌学、临床资料，并经手术、病理、细菌学证实的9例肺曲霉菌病例，在此进行回顾性分析。所有病例均行胸片、CT常规平扫及增强扫描，病灶区加5mm层厚、层距CT扫描，进行影像学分析。结果病灶分布右肺5例、左肺3例、两肺1例；病灶呈肿块或结节可单发和多发，可出现“新月征”、“洞中球征”、“晕征”、“空气支气管征”、磨玻璃样密度改变及肺片状低密度阴影。结论肺曲霉菌病有一定特征性影像表现，结合实验室及多手段病理检查，可提高临床及影像肺曲霉菌病诊断正确率，得以及时治疗。     

变应性支气管肺曲菌病的X线、CT表现

目的：提高对变应性支气管肺曲菌病（ABPA）的X线胸片及CT影像学特点的认识。方法：回顾性分析12例ABPA患者的X线胸片及CT资料,所有患者均依照目前通用的ABPA诊断标准做出诊断并经过糖皮质激素和抗霉菌药物治疗有效和痊愈。结果：12例ABPA患者的X线胸片中6例发作期见游走性浸润影,4例有局限性肺不张,8例见支气管扩张,6例合并牙膏样、树枝样或指套样阴影。CT显示12例患者均有中央型（8例柱状、囊状、其中2例合并静脉曲张型）支气管扩张并支气管黏液栓（其中5例合并高密度影）形成及以树芽征为主要表现的小叶中心结节形成。5例患者有段或叶的实变,5例有部分肺不张,1例患者合并局限性气胸。结论：ABPA的X线胸片及CT表现具有相对特征性,结合临床表现及实验室检查一般能作出明确诊断。     

肺曲霉菌病18例影像表现及诊断分析

目的分析肺曲霉菌影像学特征,以提高对该病的诊断水平。方法收集经临床病理组织学检查或痰培养证实的18例肺曲霉菌病,对其影像学表现作回顾性分析。结果18例肺曲霉菌病中,6例为曲霉菌球,典型表现为“空气半月征”及“洞内球”,10例表现为肺内单发或多发结节（肿块）,病灶周边可见斑片影（晕征）,2例表现为一侧肺上叶不张。结论肺曲霉球菌病的影像学表现具有多样性。但若出现实变与结节（he块）,绕有“晕征”的结节和楔形实变影时应考虑是否有真菌感染可能,但最终需结合病理学做出诊断。     

支气管扩张合并侵袭性肺曲霉菌病1例

男,61岁,2004年冬季开始出现咳嗽、咳黄色黏痰、量较多,偶有痰中带血丝,未治疗。之后咳嗽持续存在,间断痰中带血。2007年4月12日下午4时许,患者出现右侧胸痛,呈持续性锐痛,咯血,10h咯血量约150ml,伴有胸闷、气喘于2007年4月13日4：0收住院。体温：36．8℃、[第一段]     

Diagnosis of allergic bronchopulmonary aspergillosis

Five patients (4 men and 1 woman) afflicted with bronchopulmonary aspergillosis (ABPA) were examined. The main criteria for the diagnosis were a high level of the total IgE, demonstration of specific IgE to Aspergillus fumigatus, positive skin tests with antigens of moldy fungi. All the 4 patients with active process, not given corticosteroids, manifested eosinophilia of the sputum and peripheral blood. The clinical picture of bronchial asthma was recorded in 2 patients. It is desirable that all the patients with protracted and relapsing infiltrative processes in the lungs running with sputum and blood eosinophilia undergo examinations for the presence of ABPA.     

Pleural effusion in a patient with allergic bronchopulmonary aspergillosis

The involvement of pleura in patients with allergic bronchopulmonary aspergillosis (ABPA) is uncommon. In most reported cases the involvement of the pleura is presumed to be due to ABPA per se, due to the observed response to corticosteroids. We report a case of histopathologically proven tubercular pleural effusion in a patient with ABPA at the time of initial diagnosis. This case highlights the importance of intensive evaluation of an exudative pleural effusion in settings where pleural effusion due to the primary underlying disease is uncommon or rare.     

Diagnosis and treatment of allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is an underdiagnosed pulmonary disorder in asthmatic patients and patients with cystic fibrosis. Its clinical and diagnostic manifestations arise from an allergic response to multiple antigens expressed by fungi, most commonly Aspergillus fumigatus, colonizing the bronchial mucus. The clinical course is one of recurrent exacerbations characterized by chest infiltrates evident on chest x-ray films and associated with cough, wheeze, and sputum production that usually respond to oral corticosteroid treatment. Specific immunologic and radiologic markers of disease include elevation of the total serum IgE levels, presence of aspergillus IgE antibodies, and the occurrence of central bronchiectasis. Long-term treatment with corticosteroids is often required for effective management. The adverse effects of chronic corticosteroid use have led to attempts at treatment with antifungal agents such as itraconazole. Itraconazole has been reported anecdotally to be effective, and evidence for its effectiveness in randomized trials is still accruing. Consideration should be given to its use as a corticosteroid-sparing agent or for treatment of patients in whom corticosteroid response is poor. The natural history and prognosis of ABPA are not well characterized but may be complicated by progression to bronchiectasis and pulmonary fibrosis. If ABPA is diagnosed and treated before the development of bronchiectasis and fibrosis, these complications may be prevented.     

Experience with allergic bronchopulmonary aspergillosis: some unusual features

The clinical and immunologic features of ten patients with allergic bronchopulmonary aspergillosis (ABPA), observed over periods varying from 12 months to 10 years, are reported. Acute attacks of ABPA were characterized by several, or all of: increased cough and sputum, haemoptysis, pleuritic pain, expectoration of sputum plugs, and increasing airways obstruction. Peripheral blood eosinophilia and acutely elevated serum IgE levels were seen in all patients during acute attacks, sputum eosinophilia and recovery of Aspergillus in sputum was less common. However, blood eosinophilia was not present in all attacks of ABPA and sputum eosinophilia varied similarly from one attack to another. Six patients with previously documented multiple precipitin lines have had no demonstrable precipitins to Aspergillus on several occasions between attacks, three of these patients have also been negative during attacks. Five of the six patients have again developed positive precipitin lines. The total number of episodes in these ten patients was fifty two, three patients have had more than nine acute attacks of ABPA. There is no seasonal variation in this group of patients. Since diagnosis, only three patients have had an attack-free interval longer than 12 months. Two patients are steroid-dependent because of severe asthma, and nine have symptoms of bronchiectasis.     

HLA antigen frequencies in allergic bronchopulmonary aspergillosis.

The frequency of HLA antigens in twenty-two Caucasian patients with allergic broncho-pulmonary aspergillosis (ABPA) and sixty-nine unrelated Caucasian controls was determined. The results indicated that there was no increased frequency of a specific HLA antigen in patients with ABPA. Moreover, studies in thirteen families of ABPA patients also demonstrated that, within families, there was no consistent association between a specific haplotype and asthma, allergies or hay fever.     

In vitro T cell responses in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) occurs as a complication in patients with cystic fibrosis (CF). Previous studies of the immunopathogenesis of ABPA have indicated that B cells (IgG and IgE antibodies to Aspergillus fumigatus), T cells, and eosinophils are components of the disease. To evaluate T-cell regulation, we examined in vitro immune responses in seven patients with CF and ABPA compared with subjects who had a positive reaction to an A. fumigatus (Af) prick skin test, an IgG precipitating antibody test, or both (ST/PPT), and with subjects with CF who had negative prick skin test results and precipitating antibodies to Af (Af negative). Analyses of T-cell phenotypes revealed that patients with CF and ABPA compared with patients with CF who had ST/PPT positive and Af negative results had slightly increased percentages of T-helper cells, 50.1% versus 43.0% (p not significant) and 42.2 (p less than 0.025), respectively, but comparable percentages and numbers of T-suppressor cells. Serum IgE concentrations were significantly increased in subjects with CF and ABPA versus both subjects who had ST/PPT-positive and Af-negative results, 2916 versus 281 and 73 IU/ml (p less than 0.001 and less than 0.001, respectively). In addition, B cells from patients with CF and ABPA had significantly increased in vitro preformed IgE (p less than 0.01) and increased spontaneous de novo IgE spontaneous synthesis compared with cells from subjects who had ST/PPT positive and Af-negative results (p less than 0.01 and less than 0.01), indicating prior in vivo activation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relation of bronchial asthma and allergic bronchopulmonary aspergillosis

An allergological examination was conducted in 30 out of 83 (36.07%) patients showing symptoms of bronchial asthma. It was found that skin hypersensitivity to Aspergilla allergens coupled with a high serum IgE level. The appropriateness of such affection referral to a separate nosological entity (allergic bronchopulmonary aspergillosis) is under discussion.