摘要
目的 了解慢性阻塞性肺疾病（简称慢阻肺）合并变应性支气管肺曲霉病（ABPA）的临床表现及影像学特征,以提高认知水平.方法 回顾性分析北京同仁医院2009年1月至2012年12月诊断的3例慢阻肺合并ABPA病例的临床资料.结果 3例慢阻肺合并ABPA患者均为男性,年龄68 ～ 82岁,均以咳嗽、咳痰、活动后气短为主要表现,伴发作性喘息；既往均无支气管扩张症、支气管哮喘、变应性鼻炎、鼻窦炎及湿疹等疾病史及支气管哮喘家族史.均有吸烟史.肺功能检查显示阻塞性通气功能障碍,吸入支气管舒张剂后FEV1/FVC分别为30％、33％和43％,均符合慢阻肺的诊断标准,依据慢阻肺诊断、处理和预防全球策略的肺功能严重程度分级,1例为Ⅲ级,2例为Ⅳ级.高分辨率CT均显示肺气肿伴或不伴有肺大疱.3例均存在曲霉抗原皮试速发反应阳性,血清总IgE＞1000kU/L,血清曲霉特异性IgE增高（＞0.35 kU/L）,血清曲霉特异性IgG增高（＞40 mg/L）,高分辨率CT显示不同程度的支气管扩张.此外,3例的外周血嗜酸粒细胞比值均＞0.05,曾出现肺部浸润阴影,2例曾咳褐色痰栓,1例痰培养烟曲霉阳性,3例均符合ABPA的诊断标准.确诊后给予口服泼尼松治疗,呼吸困难和FEV1均明显改善.结论 慢阻肺合并ABPA在临床上较为少见,及时诊断和治疗有利于改善症状和预后.临床上对于反复出现发作性喘息及常规治疗不能控制的慢阻肺病例,应考虑有合并ABPA的可能性.
Objective To improve the clinical knowledge on allergic bronchopulmonary aspergillosis （ABPA） combined with COPD by report of cases.Methods We retrospectively analyzed the clinical information of 3 cases of ABPA combined with COPD diagnosed in our hospital from Jan.2009 to Dec.2012.Results The 3 patients were all males,and aged from 68 to 82 years.The main complaints of all the patients were exertional dyspnea,cough and sputum production,with episodes of wheezing.All patients denied the history of allergic diseases,e.g.,asthma,rhinitis,sinusitis,eczema,and family history of asthma.They all had a history of heavy smoking.The pulmonary function tests indicated obstructive impairment,and the ratio of FEV1 to FVC （FEV1/FVC） after bronchodilators were 30%,33% and 43%,respectively,with no significant bronchodilator reversibility,which were consistent with the diagnostic criteria for COPD,with 1 case in GOLD grade Ⅲ and 2 cases in GOLD grade Ⅳ based on the GOLD spirometric criteria for COPD severity.Lung HRCT showed emphysema with or without bulla formation.All cases showed immediate positive response to Aspergillus antigen by skin prick test （SPT）,increased serum total IgE 〉 1000 kU/L,increased serum level of Aspergillus specific IgE （〉 0.35 kU/L） and IgG （〉 40 mg/L）.Central bronchiectasis was also evident on HRCT scan in the 3 patients.In addition,the eosinophil percentage in peripheral blood was all 〉 5%.Pulmonary infiltrates,brown phlegm plugs,and growth of Aspergillus fumigatus were also noted in some cases.After the diagnosis of ABPA,the patients were all given oral prednisone therapy,with notable improvement in dyspnea and FEV1.Conclusions ABPA in COPD is uncommon,but early identification and initiation of systemic corticosteroid therapy can lead to improvement in symptoms and prognosis.For COPD patients with recurrent attacks of wheezing or are unresponsive to combination therapy of inhaled long-acting bronchodilators and corticosteroids,concurrent ABPA should be suspected and inv
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2013年第10期741-745,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
基金
国家自然科学基金（81170039）
关键词
肺疾病
慢性阻塞性
曲霉病
变应性支气管肺
Puhnonary disease, chronic obstructive
Aspergillosis, allergic bronchopuhnonary
