变应性支气管肺曲霉菌病的HRCT表现广州市番禺区人民医院_临床医学论文.docVIP

变应性支气管肺曲霉菌病的HRCT表现广州市番禺区人民医院_临床医学论文 变应性支气管肺曲霉菌病的HRCT表现广州市番禺区人民医院_临床医学论文 作者：陈广源 陈汉威 邓宇 郑晓涛 陈淮 蓝日辉 【摘要】 目的 评价变应性支气管肺曲霉菌病的HRCT表现。 方法 回顾性分析7例变应性支气管肺曲霉菌病患者的肺部高分辨率CT图像。 结果 7例（100％）患者均可见到中心性支气管扩张，共累及28/35个（80％）肺叶和70/126个（55％）肺段；7例（100％）扩张支气管腔内均可见粘液嵌塞，呈指套样、牙膏状改变，其中5例（71％）为稍高密度，1例（14％）可见到钙化；4例（57％）可见肺实变；2例（28％）合并肺叶含气不全；3例（42％）合并肺门淋巴结增大。 结论 长期哮喘的病人如果HRCT上发现中心性支气管扩张，同时管腔内可见稍高密度的粘液嵌塞或高密度钙化，需考虑ABPA的可能。 【关键词】 体层摄影术; X线计算机；曲霉菌病; 变应性支气管肺；真菌病 [Abstract] Objective To study the HRCT features of Allergic Bronchopulmonary Aspergillosis. Methods The lung HRCT of 7 cases were all reviewed retrospectively. Results The HRCT depicted central bronchiectasis in 7 cases (100%), involving 28/35(80%) lobes and 70/126 (55%) segments; The mucoid impaction of the dilated bronchial tree wee seen in all 7 cases (100%), presenting as gloved-finger and toothpaste appearance, while some mucus were slightly hyperdensen of 5 cases and were high-attenuation calcification of 1 case; Consolidation were found in 4 cases (57%); 2 cases (28%) complicated with lobar atelectasis; Hilar lymphadenopathy was seen in 3 cases (42%). Conclusion The diagnosis of ABPA should be considered in a patient with long-standing asthma whose HRCT demonstrates central bronchiectasis with slightly hyperdense mucoid impaction or high-attenuation calcification. [Keywords] tomography; X-Ray computed; aspergillosis; allergic bronchopulmonary; mycoses 变应性支气管肺曲霉菌病 (Allergic Bronchopulmonary Aspergillosis, ABPA）是机体对曲霉菌（Aspergillus, Asp.）抗原特别是烟曲菌(Aspergillus fumigatus, Af.)的过敏反应，多见于长期哮喘的病人[1]，临床上常误诊为结核或普通支气管扩张，延误了疾病的诊治，高分辨率CT（High Resolution CT，HRCT）由于采用了高分辨率算法重建图像，显著提高了肺微细病变的空间分辨率显示率，可提高与大体标本媲美的肺部解剖细节，是当今活体无创性肺部成像技术中最灵敏的工具[2]，故本文特对我院诊治的7例ABPA患者的HRCT图像进行回顾性分析，以期提高对该病HRCT征象的认识，利于早期诊断及治疗。 材料与方法 1.一般资料 收集经临床或病理确诊的ABPA患者7例，其中男性4例，女性3例，男:女为4：3，年龄22～80岁，平均49岁。临床表现主要有咳嗽7例，咳痰7例，喘息7例，气促4例，2例对虾或花粉过敏。所有病人均符合变应性支气管肺曲霉菌病-中心性支气管扩张（ABPA-CB）的诊断标准：（1）哮喘；（2）中心性支气管扩张（肺野的内2/3区域）;（3）Asp或Af变应原皮试速发反应阳性；（4）血清总IgE 浓度gt;417 kU/L(gt;1000ng/ml)；（5）血清IgE-Af,IgG-A