8例变态反应性支气管肺曲菌病临床特点分析

目的分析变态反应性支气管肺曲霉菌病(ABPA)的临床特点,以提高临床医师认识,减少误诊漏诊,及早发现疾病复发。方法对我院确诊的8例ABPA患者的临床资料进行回顾性分析。结果 8例ABPA患者,女5例,男3例,年龄28~55岁,平均(41.75±9.51)岁。主要临床表现为咳嗽8例(100%),咳痰8例(100.0%),胸闷8例(100.0%)。8例外周血嗜酸粒细胞计数均500/μL,8例烟曲霉特异性IgE均0.35 KUA/L,6例血总IgE1000IU/L。胸部CT示支气管扩张8例,两肺渗出影6例,黏液嵌塞征3例,实变影2例,肿块影2例。6例行痰培养示烟曲霉(+)、3例行BALF培养示烟曲霉(+)。8例均给予全身糖皮质激素联合抗真菌治疗,病情缓解。随访中3例复发。结论对反复发作哮喘合并支气管扩张患者应高度警惕ABPA的可能,应常规行外周血EOS计数、外周血总IgE及胸部HRCT检查,有条件者行烟曲霉特异性IgG、IgE检测及曲霉皮肤试验检查,以提高诊断率、减少漏诊。随访中监测外周血总IgE变化,及早发现疾病复发。

Analysis of clinical characteristics of 8 cases of allergic bronchopulmonary aspergillosis

Objective To analyze the clinical characteristics of allergic bronchopulmonary aspergillosis(ABPA),to improve the clinician''s understanding,reduce misdiagnosis and missed diagnosis,so as to detect disease recurrence in a timely manner.Methods The clinical data of 8 patients with ABPA who were diagnosed in our hospital were retrospectively analyzed.Results There were 8 cases of ABPA patients,with 5 females and 3 males,aged 28 to 55 years,with the mean age of(41.75±9.51)years old.The main clinical manifestations were cough in 8 cases(100.0%),sputum in 8 cases (100%),and chest tightness in 8 cases(100.0%).8 cases of peripheral blood eosinophil count were>500/uL,8 cases of aspergillus fumigatus specific IgE were greater than 0.35 KUA/L,and 6 cases of total blood IgE>1000 IU/L.Thoracic CT showed bronchiectasis in 8 cases,bilateral lung exudation in 6 cases,mucus impaction in 3 cases,consolidation shadow in 2 cases,and mass shadow in 2 cases.6 cases of sputum culture showed aspergillus fumigatus(+),3 cases of BALF culture showed aspergillus fumigatus(+).8 cases were all given systemic glucocorticoid combined with antifungal therapy,followed by remission.There were three patients with recurrence during follow-up visit.Conclusion Patients with recurrent asthma complicated with bronchiectasis should be highly alert to the possibility of ABPA.They should be given routine peripheral blood EOS count,peripheral blood total IgE and chest HRCT examinations.If condition permits,the patients can be given aspergillus fumigatus specific IgG,IgE tests and aspergillus skin test to improve the diagnostic rate and reduce missed diagnosis.During follow-up visit,peripheral blood total IgE changes should be monitored,so as to detect disease recurrence in a timely manner.