中心性支气管扩张型变态反应性支气管肺曲霉菌病的临床治疗反应

目的评价中心性支气管扩张型变态反应性支气管肺曲霉菌病患者对不同治疗方案的治疗反应。方法回顾性收集31例中心性支气管扩张型变态反应性支气管肺曲霉菌病患者的临床资料。根据治疗方案,将研究对象分为联合治疗组(伊曲康唑联合强的松治疗,联合组)和强的松治疗组(强的松组)。比较在治疗2个月时,两组患者的症状、IgE水平、嗜酸性粒细胞计数、肺功能、血气分析和不良反应等临床指标。结果治疗2个月时,联合治疗组患者的症状改善更明显,痰液烟曲菌培养转阴。联合治疗组IgE水平由(1 948±377)IU/mL降至(742±281)U/mL,强的松组由(1 851±526)IU/mL降至(1 109±367)IU/mL(P=0.023);两组嗜酸性粒细胞计数均显著降低(P=0.315);联合治疗组FEV1(%pred)由(39.6±7.5)%升至(79.7±10.5)%,强的松组由(42.1±9.1)%升至(68.3±11.7)%(P=0.019),而FEV1/FVC均升高不明显(P=0.712)。联合治疗组动脉血氧分压由(53±7)mmHg升至(83±11)mmHg,强的松组由(56±12)mmHg升至(71±9)mmHg(P=0.041)。联合治疗组中有6例患者有恶心、呕吐和胃部不适等消化系统症状,5例患者肝功酶学轻度异常。结论强的松联合伊曲康唑可更有效地治疗中心性支气管扩张型变态反应性支气管肺曲霉菌病。

Therapeutic effect of allergic bronchopulmonary aspergillosis-central bronchiectasis

Objective To evaluate the therapeutic effect of allergic bronchopulmonary aspergillosis-central bronchiectasis. Methods Retrospectively collected the clinical data of 31 allergic bronchopulmonary aspergillosis-central bronchiectasis patients. These patients were divided into two groups：glucocorticosteroid combined with itraconazole treatment（ combination therapy group）and prednisone treatment（ prednisone group）. Then the symptoms, IgE level, eo- sinophil count, pulmonary function, blood gas analysis and adverse reactions were compared between the two groups. Results The symptoms were better and sputum culture was negative in combination therapy group treated for two months. IgE level fell from （1 948 ±377） IU/rnL to （742 ±281 ） IU/mL in combination therapy group,from （ 1 851 ± 526）IU/mL to （1 109 ±367） IU/mL in prednisone group（P =0. 023）. Eosinophil count dropped significantly in both groups（P =0. 315）. FEV1 （ % pred）increased from（39. 6 ±7.5） % to（79. 7 ＋ 10. 5） % in combination therapy group, from（42. 1 ± 9. 1 ） % to （ 68.3 ＋ 11.7 ） % in prednisone group （ P = 0. 019 ）. FEV1/FVC increased insignificantly in both groups （ P = 0. 712 ）. Arterial oxygen partial pressure rose from （ 53 ± 7 ） mmHg to （ 83 ± 11 ） mmHg in combination therapy group, from （56 ± 12）mmHg to （71 ± 9 ）mmHg in prednisone group （P = 0. 041 ）. Six patients had nausea, vomiting, and gastric discomfort. Five patients had mild hepatic enzymes abnormalities. Conclusion Glucocorticosteroid combined with itraconazole can more effectively treat allergic bronchopulmonary aspergillosis-central bronchiectasis.