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...

Clinical analysis of 11 cases of allergic bronchopulmonary aspergillosis

Objective To describe the clinical features and diagnosis of allergic bronchopulmonary aspergillosis (ABPA).Methods Eleven cases of ABPA from our hospital were presented,and the clinical data were analyzed.Results There were five male and six female patients,aged from 46 to 85 (mean 67 + 12) years.The main clinical manifestations included wheeze ( n =11 ),cough ( n =10),expectoration ( n =10),sputum plugs ( n =3),and hemoptysis ( n =2).Immediate cutaneous reaction to A.fumigatus was positive in all the cases.Serum total IgE was elevated in 11 cases,higher than 1 000 μg/L in nine of them.A.fumigatus-specific IgE was elevated in all the cases,range 5.04-118.56 μg/L,grade Ⅱ-Ⅳ.Peripheral eosinophilia was present in six cases (range 6.1％-29.7％).Chest HRCT showed patchy infiltration in eleven cases (fleeting infiltration in ten cases),and central bronchiectasis in nine cases (signs of mucous plugs in four cases).Obstructive ventilatory dysfunction was found in ten cases FEV1 / FVC (57 + 11 ) ％,FEV1 ％ pred (48 + 15) ％ ],with five showing airflow reversibility.Refractory asthma,chronic obstructive pulmonary disease or bronchiectasis had been diagnosed initially in all the cases.Glucocorticoid therapy was administered in ten cases,and the disease was improved,but one patient in the late stage died of respiratory failure.Conclusions For patients with refractory asthma or bronchiectasis with wheezing,ABPA should be considered.Measurement of total IgE,immediate cutaneous reaction to A.fumigatus and chest HRCT are helpful for confirmation of the diagnosis.