变应性支气管肺曲霉病四例临床分析并文献复习

发布时间：2018-04-04 14:51

本文选题：变应性支气管肺曲霉病　切入点：诊断　出处：《中国呼吸与危重监护杂志》2015年05期

【摘要】：目的总结变应性支气管肺曲霉病(ABPA)的临床特点、诊断及治疗方法。方法结合文献资料分析我科2009年至2014年确诊的4例ABPA的临床病例。结果 ABPA常发生于支气管哮喘和囊性肺纤维化的患者。临床主要表现为喘息发作、发热、咳嗽、咳痰等症状,实验室检查表现为快速烟曲霉皮试阳性,总血清Ig E水平和曲霉特异的Ig E和Ig G水平上升,以及嗜酸粒细胞增加等;胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和伊曲康唑抗真菌治疗。结论临床上ABPA容易误诊误治,对于未控制的支气管哮喘患者或哮喘患者伴有急性肺浸润,应考虑该病的可能。早期诊断和合理治疗可以减少ABPA造成的肺损伤,改善患者的预后。
[Abstract]:Objective to summarize the clinical features, diagnosis and treatment of allergic bronchopulmonary aspergillosis (ABPA).Methods the clinical data of 4 cases of ABPA from 2009 to 2014 were analyzed.Results ABPA often occurred in patients with bronchial asthma and cystic pulmonary fibrosis.The main clinical manifestations were wheezing, fever, cough, expectoration and other symptoms. Laboratory examination showed that Aspergillus fumigatus skin test was positive, total serum IgE level and Aspergillus specific IgE and IgG levels increased, and eosinophils increased.Chest imaging features of recurrent pulmonary wandering infiltration and central bronchiectasis.Treatment includes glucocorticoid and itraconazole antifungal therapy.Conclusion ABPA is easy to be misdiagnosed and mistreated clinically, and the possibility of this disease should be considered for patients with uncontrolled bronchial asthma or asthma with acute pulmonary infiltration.Early diagnosis and reasonable treatment can reduce lung injury caused by ABPA and improve prognosis.
【作者单位】：上海交通大学医学院附属新华医院呼吸科;上海交通大学医学院附属新华医院病理科;上海交通大学医学院附属新华医院放射科;
【分类号】：R519

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