摘要
目的总结分析22例变态反应性支气管肺曲霉菌病(ABPA)患者的临床特点,以提高对ABPA的认识。方法回顾性分析同济大学附属上海肺科医院呼吸科2002年1月至2008年7月22例ABPA患者的临床、影像学表现、实验室检查、病理及疗效。结果 (1)22例ABPA患者中,男13例,女9例,有气喘症状者16例,无气喘症状者6例,且部分患者肺部听诊未闻及哮鸣音。(2)有中心性支气管扩张者19例,以上叶支气管受累多见。(3)单纯糖皮质激素治疗者2例。联合抗真菌治疗者19例,其中1例为单纯使用糖皮质激素症状反复,加用伊曲康唑后好转;1例为联合伊曲康唑治疗,症状好转,停用抗真菌治疗后症状反复,再次联用。结论气喘是ABPA患者最常见的临床症状,但也有近1/3病例无支气管哮喘病史;中心性支气管扩张伴黏液栓形成是ABPA的特征性表现,可提示诊断并帮助判断预后,但也有患者不具备中心性支气管扩张,应结合其他资料综合分析后作出正确诊断;联合抗真菌药物治疗可明显提高疗效,减少激素用量。
Objective To impove the cognition of allergic bronchopulmonary aspergillosis by analyzing its clinical characteristics. Methods 22 patients diagnosed as having allergic bronchopulmonary aspergillosis in our hospital were studied in their clinical characteristics, imaging findings, laboratory inspections, pathologies, therapies and follow-up results. Results （ 1 ） The patients consisted of 13males and 9 femailes. Asthma was present in 16 patients, and absent in 6 cases, some of which had no wheezing heard in lung auscultation. （2） Central bronchiee- tasis was present in 19 cases ,with the upper lobe bronchial mainly involved. （3）Simple glucocorticoid therapy was used in 2 cases,the joint anti-fungal therapy in 19 cases （one case improved combined with itraconazole therapy after recurrence and one case improved with the joint itraconazole treatment, followed by recurrence of the symptoms after discontinued antifungal therapy and by the combination therapy again）. Conclusion Clinical asthma is the most common symptom of ABPA. However, there are one-third of cases without history of asthma. Central bronehiectasis with formation of mucus suppository is a characteristic feature of ABPA which can prompt diagnosis and help in the prognosis. The combination of antifungal treatment can lead to improvement and reduce or eliminate the need of glucocorticoid therapy.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2010年第5期441-443,共3页
Chinese Journal of Practical Internal Medicine
