本文選題：變應(yīng)性支氣管肺曲霉病　切入點：診斷　出處：《中國呼吸與危重監(jiān)護雜志》2015年05期

【摘要】：目的總結(jié)變應(yīng)性支氣管肺曲霉病(ABPA)的臨床特點、診斷及治療方法。方法結(jié)合文獻資料分析我科2009年至2014年確診的4例ABPA的臨床病例。結(jié)果 ABPA常發(fā)生于支氣管哮喘和囊性肺纖維化的患者。臨床主要表現(xiàn)為喘息發(fā)作、發(fā)熱、咳嗽、咳痰等癥狀,實驗室檢查表現(xiàn)為快速煙曲霉皮試陽性,總血清Ig E水平和曲霉特異的Ig E和Ig G水平上升,以及嗜酸粒細(xì)胞增加等;胸部影像學(xué)表現(xiàn)為反復(fù)的肺部游走性浸潤影和中心性支氣管擴張等。治療包括糖皮質(zhì)激素和伊曲康唑抗真菌治療。結(jié)論臨床上ABPA容易誤診誤治,對于未控制的支氣管哮喘患者或哮喘患者伴有急性肺浸潤,應(yīng)考慮該病的可能。早期診斷和合理治療可以減少ABPA造成的肺損傷,改善患者的預(yù)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.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院呼吸科;上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院病理科;上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院放射科;
【分類號】：R519

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本文編號：1710429