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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 IgE349～13000 IU/ml,其中≥5000 IU/ml 者7例,2500～5000 IU/ml 者6例,1000～2500 IU/ml 者5例。肺功能检查18例,第1秒钟用力呼气容积(FEV_1)占预计值百分比为(54.7±24.1)%,(FEV_1/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,树杈样或条状痰栓征象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 summarize and analyze the clinical features of allergic bronchopulmonary aspergillosis (ABPA) in order to improve the understanding of ABPA and achieve early diagnosis and early treatment. Methods The clinical data of ABPA patients diagnosed in Peking Union Medical College Hospital in recent 20 years were retrospectively analyzed. Results 23 cases of ABPA patients, 11 males and 12 females, age (34.0 ± 13.2) years old. Before the diagnosis of ABPA was misdiagnosed as tuberculosis in 12 cases, 3 cases of pneumonia, lung cancer in 2 cases, Wegener granuloma in 1 case. Symptoms included cough (23 cases), sputum (22 cases), asthma (18 cases), sputum suppository (16 cases), fever (15 cases, including 4 cases of fever), hemoptysis (12 cases), chest pain Cases), weight loss (7 cases). The absolute value of peripheral blood eosinophils (0.18 ~ 15.34) × 10 ~ 9 / L, the median 1.43 × 10 ~ 9 / L; eosinophils 0.016 ~ 0.721, median 0.148. Peripheral blood total IgE349 ~ 13000 IU / ml, of which ≥ 5000 IU / ml in 7 cases, 2500 ~ 5000 IU / ml in 6 cases, 1000 ~ 2500 IU / ml in 5 cases. Pulmonary function tests were performed in 18 patients. The predicted FEV 1 (54.7 ± 24.1)%, FEV 1 / forced expiratory volume × 100% (62.5 ± 11.9)%, reversible test The positive rate of 56%. Thoracic CT examination in 22 cases showed patchy exudative in 21 cases, central bronchiectasis in 17 cases, nodules in 9 cases, twigs or stripe sputum signs in 6 cases, consolidation in 5 cases, increased mediastinal lymph nodes Large in 11 cases; pathological changes were migratory in 17 cases. Conclusions ABPA can be easily misdiagnosed as pulmonary tuberculosis in clinic. If patients have asthma, pulmonary function obstructive ventilatory dysfunction, peripheral eosinophils increase, chest radiography shows migratory pulmonary infiltrates, more central bronchus Expansion can further check the total IgE, Aspergillus fumigatus specific IgE, Aspergillus fumigatus allergen skin test to confirm.