摘要
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。
Objective To describe the clinical characteristics of allergic bronchopulmonary aspergillosis（ABPA）. Methods The clinical presentations, serologic results, lung function data, chest radiology and the results of treatment of 23 patients with ABPA in Peking Union Medical College Hospital were retrospectively analyzed. Results There were 11 males and 12 females, with a mean age of （34. 0 ± 13.2） yrs. Tuberculosis,pneumonia, lung cancer and Wegener＇s granulomatosis were initially diagnosed in 12, 3, 2 and 1 cases respectively. Cough was present in all patients and sputum production in 22 cases, wheeze in 18,sputum plugs in 16, fever in 15 （high degree of fever in 4）, bemoptysis in 12, chest pain/ backache in 8 and weight loss in 7 cases. Forced expired volume in one second （ FEV1 ） was （ 54. 7 ± 24. 1 ） % predicted, and FEV1/forced vital capacity（FVC） was （ 62.5 ± 11.9） %. The FEV1 reversibility was found in 56% （9/16）of the patients. Chest CT were performed in 22 cases. Patchy infiltrations were present in 21, central bronchiectasis in 17, nodular opacities in 9, mucoid impaction （ glover-finger/band linear opacities） in 6, consolidation in 5, and mediastinal adenopathy in 11 cases, while 17 cases presented fleeting infiltrations. Twenty-two patients were treated with prednisone plus itraconazele and 17 patients were followed. The median follow up time was 26. 2 months（ 13 days - 19 years）. Pulmonary infiltrations relapsed in 9 patients and not appeared for more than 6 years in only one patient. Conclusions ABPA was mostly misdiagnosed as tuberculosis. Wheeze is present in almost all patients with ABPA, which can be useful in differentiation from tuberculosis. Obstructive ventilatory defect, peripheral blood eosinophilia, fleeting pulmonary infiltration and central bronchiectasis were features of ABPA. Measurement of total IgE, A.fumigatus-specific IgE levels and immediate cutaneous reaction to A.fumigatus are helpful for confirmation of the diagnosis.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2007年第3期208-212,共5页
Chinese Journal of Internal Medicine
