变应性支气管肺曲霉病26例临床分析
|
摘要
目的总结分析变应性支气管肺曲霉病(ABPA)的临床特点。方法回顾性分析郑州大学第一附属医院2016年9月至2018年2月确诊为ABPA的26例患者临床资料。结果 26例ABPA患者中,男15例,女11例,平均年龄(47.6±11.7)岁。在确诊ABPA之前诊断为哮喘的有13例,8例误诊为支气管扩张症,8例误诊为肺部感染,3例误诊为肺结核。咳嗽、咳痰26例,喘息21例,发热5例,咯血4例,胸痛4例,呼吸困难2例。20例肺部可闻及哮鸣音,4例可闻及湿性啰音。26例患者血清总IgE均升高,为654～5 337 IU/ml,中位数为5 000 IU/ml;23例外周血嗜酸性粒细胞绝对值升高,为(0.50～3.69)×109/L,中位数为0.99×109/L;23例外周血嗜酸性粒细胞百分比升高,平均为0.36±0.10;10例曲霉皮肤点刺实验阳性;26例均行血清特异性烟曲霉IgE结果均升高,为0.4～29.6 kU/L,中位数为15.1 kU/L;16例行支气管镜检查,5例行支气管镜肺活检,2例行经皮穿刺肺活检;胸部X线片主要表现为肺部游走性实变影;胸部CT主要表现为多发性斑片状影、中心性支气管扩张、黏液栓、树芽征或指套征等;14例给予口服糖皮质激素联合抗真菌药物治疗。结论 ABPA在我国相对少见且临床表现缺乏特异性,在疾病早期容易误诊为哮喘,临床医生应该提高对本病的认识,以达到对ABPA患者做到早期诊断并给予正规治疗。对于已确诊ABPA的患者,应注意定期随访,以降低复发加重风险。
Objective To analyse the clinical characteristics of allergic bronchopulmonary aspergillosis(ABPA).Methods The clinical data of 26 patients diagnosed as ABPA from September 2016 to February 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among 26 patients with ABPA,15 were female, 11 were male, with a mean age of(47.6±11.7) years. Before the diagnosis of ABPA, 13 cases had been misdiagnosed as bronchial asthma, 8 as bronchiectasis, 8 as pulmonary infection, 3 as tuberculosis. All patients had cough,sputum production, wheeze in 2, fever in 5, hemoptysis in 4, chest pain in 4, dyspnea in 2. The wheezing sound were heard in 20 patients and wet rales were heard in 4 cases. All patients had increased total IgE level [median 5 000(654 –5 337)IU/ml]. The eosinophil counts were increased in 23 patients [median 0.99(0.50 – 3.69)×109/L] and percentages of peripheral blood eosinophil were elevated to(0.36±0.10). Skin prink test was positive in 10 cases. All patients had increased Aspergillus fumigatus specific IgE [median 15.1(0.4 – 29.6)kU/L). Chest X-ray showed fleeting consolidation. Chest CT showed multiple pachy, central cylindrical bronchiectasis, mucous plugging, band linear or glover-finger opacities. Sixteen cases underwent bronchoscopy, out of them 5 cases underwent transbronchial lung biopsy, 2 cases underwent CT guided percutaneous lung biopsy. Fourteen cases were treated with oral corticosteroids combined with antifungal therapy. Conclusions ABPA is a relatively rare and without specific clinical manifestations.In the early period, it is mostly misdiagnosed as bronchial asthma, so it is necessary to improve the early diagosis of ABPA and give appropriate treatment. Regular follow-up should be made to prevent the recurrence.
Objective To analyse the clinical characteristics of allergic bronchopulmonary aspergillosis(ABPA).Methods The clinical data of 26 patients diagnosed as ABPA from September 2016 to February 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Results Among 26 patients with ABPA,15 were female, 11 were male, with a mean age of(47.6±11.7) years. Before the diagnosis of ABPA, 13 cases had been misdiagnosed as bronchial asthma, 8 as bronchiectasis, 8 as pulmonary infection, 3 as tuberculosis. All patients had cough,sputum production, wheeze in 2, fever in 5, hemoptysis in 4, chest pain in 4, dyspnea in 2. The wheezing sound were heard in 20 patients and wet rales were heard in 4 cases. All patients had increased total IgE level [median 5 000(654 –5 337)IU/ml]. The eosinophil counts were increased in 23 patients [median 0.99(0.50 – 3.69)×109/L] and percentages of peripheral blood eosinophil were elevated to(0.36±0.10). Skin prink test was positive in 10 cases. All patients had increased Aspergillus fumigatus specific IgE [median 15.1(0.4 – 29.6)kU/L). Chest X-ray showed fleeting consolidation. Chest CT showed multiple pachy, central cylindrical bronchiectasis, mucous plugging, band linear or glover-finger opacities. Sixteen cases underwent bronchoscopy, out of them 5 cases underwent transbronchial lung biopsy, 2 cases underwent CT guided percutaneous lung biopsy. Fourteen cases were treated with oral corticosteroids combined with antifungal therapy. Conclusions ABPA is a relatively rare and without specific clinical manifestations.In the early period, it is mostly misdiagnosed as bronchial asthma, so it is necessary to improve the early diagosis of ABPA and give appropriate treatment. Regular follow-up should be made to prevent the recurrence.
引文
1 Singh SI, Agarwal R. Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations. Eur Respir Rev,2014, 23(131):149-152.
2 Reddy A, Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract, 2017, 5(3):866-867.
3中华医学会呼吸病学分会哮喘学组.变应性支气管肺曲霉病诊治专家共识.中华医学杂志,2017, 97(34):2650-2656.
4 Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of Aspergillosis:Clinical Practice Guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46(3):327-360.
5任少华,胡华成.变态反应性支气管-肺烟曲菌病的临床研究进展.中国呼吸与危重监护杂志,2003, 2(5):62-64.
6马艳良,张为兵,余兵,等.支气管哮喘患者中变应性支气管肺曲霉病的检出及临床特点初步调查.中华结核和呼吸杂志,2011,34(12):909-913.
7 Agarwal R,Aggarwal AN, Gupta D, et al. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma:systematic review and metaanalysis. Int J Tuberc Lung Dis, 2009, 13(8):936-944.
8 Agarwal R,Chakrabarti A, Shah A,et al. Allergic bronchopulmonary aspergillosis:review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013,43(8):850-873.
9 Sunzini F, Barbato C, Canofari C, et al. Clinical and radiological signs of ABPA associated with airways infection with Aspergillus in the absence of specific IgE. Eur Ann Allergy Clin Immunol, 2016,48(5):202-204.
10 Schwartz HJ,Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma,determined by serologic and radiologic criteria in patients at risk.J Lab Clin Med, 1991, 117(2):138-142.
11陆海雯,卫平,徐金富.变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展.中国呼吸与危重监护杂志,2014, 13(5):534-536.
12 Agarwal R, Khan A, Garg M, et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol, 2012, 4(4):141-150.
13 Agarwal R. Allergic bronchopulmonary aspergillosis. Chest, 2009,135(3):805-826.
14 Moss RB. Treating allergic bronchopulmonary aspergillosis:the way forward. Eur Respir J, 2016,47(2):385-387.
15 Agarwal R, Aggarwal AN, Dhooria S, et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2016, 47(2):490-498.
16 Jat KR, Walia DK, Khairwa A. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis.Cochrane Database Syst Rev, 2018, 3:D10288.
17 Leon EE, Craig TJ. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol,1999, 82(6):511-516.
18 Zirbes JM, Milla CE. Steroid-sparing effect of omalizumab for allergic bronchopulmonary aspergillosis and cystic fibrosis. Pediatr Pulmonol, 2008, 43(6):607-610.
19 Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med, 2010,104(2):204-210.
2 Reddy A, Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract, 2017, 5(3):866-867.
3中华医学会呼吸病学分会哮喘学组.变应性支气管肺曲霉病诊治专家共识.中华医学杂志,2017, 97(34):2650-2656.
4 Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of Aspergillosis:Clinical Practice Guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46(3):327-360.
5任少华,胡华成.变态反应性支气管-肺烟曲菌病的临床研究进展.中国呼吸与危重监护杂志,2003, 2(5):62-64.
6马艳良,张为兵,余兵,等.支气管哮喘患者中变应性支气管肺曲霉病的检出及临床特点初步调查.中华结核和呼吸杂志,2011,34(12):909-913.
7 Agarwal R,Aggarwal AN, Gupta D, et al. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma:systematic review and metaanalysis. Int J Tuberc Lung Dis, 2009, 13(8):936-944.
8 Agarwal R,Chakrabarti A, Shah A,et al. Allergic bronchopulmonary aspergillosis:review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013,43(8):850-873.
9 Sunzini F, Barbato C, Canofari C, et al. Clinical and radiological signs of ABPA associated with airways infection with Aspergillus in the absence of specific IgE. Eur Ann Allergy Clin Immunol, 2016,48(5):202-204.
10 Schwartz HJ,Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma,determined by serologic and radiologic criteria in patients at risk.J Lab Clin Med, 1991, 117(2):138-142.
11陆海雯,卫平,徐金富.变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展.中国呼吸与危重监护杂志,2014, 13(5):534-536.
12 Agarwal R, Khan A, Garg M, et al. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol, 2012, 4(4):141-150.
13 Agarwal R. Allergic bronchopulmonary aspergillosis. Chest, 2009,135(3):805-826.
14 Moss RB. Treating allergic bronchopulmonary aspergillosis:the way forward. Eur Respir J, 2016,47(2):385-387.
15 Agarwal R, Aggarwal AN, Dhooria S, et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2016, 47(2):490-498.
16 Jat KR, Walia DK, Khairwa A. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis.Cochrane Database Syst Rev, 2018, 3:D10288.
17 Leon EE, Craig TJ. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol,1999, 82(6):511-516.
18 Zirbes JM, Milla CE. Steroid-sparing effect of omalizumab for allergic bronchopulmonary aspergillosis and cystic fibrosis. Pediatr Pulmonol, 2008, 43(6):607-610.
19 Agarwal R, Gupta D, Aggarwal AN, et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med, 2010,104(2):204-210.