19例变态反应性支气管肺曲霉病临床分析.pdfVIP

老年医学与保健2008年第l4卷第1期 Gerialr Health Care，2008，Vo1．14．N L1．1 1 9例变态反应性支气管肺曲霉病临床分析 龚 瑾 胡必杰 朱惠莉 李向阳 【摘要】 目的 总结分析不同类型变态反应性支气管肺曲霉病(allergic bronehopulmonary aspergillosis,ABPA)的 临床特点，提高对ABPA的认识，做到早诊断早治疗。方法 分析中山医院近5年确诊的19例ABPA患者的临床资料， 分为变态反应性支气管肺曲菌病一血清IgE增高型组和变态反应性支气管肺曲菌病一中心支气管 张型组，比较两 组病人的临床症状和实验室特点。结果 19例ABPA患者中男1 J例，女8例，在确诊前被误诊为肺结核的有8例，误 诊为肺癌的有3例，其他诊断包括支气管哮喘、过敏性肺炎、Wegener肉芽肿等。两组病人在年龄、性别、症状等方面 差别无统计学意义，但ABPA伴中心型支气管扩张组的嗜酸粒细胞和血清总IgE水平比血清IgE增高型的ABPA组升 高(P0．01)，而第一秒用力呼气容积占预计值百分比则降低 O．01)。结论 不伴中心型支气管扩张的ABPA可能是 疾病的早期或侵袭性较弱的一种形式，为避免肺功能出现不可逆的改变，对气喘、肺部出现游走性浸润影、嗜酸性粒 细胞及IgE升高者应进一步查肺cT、烟曲菌特异性IgE和烟曲菌抗原皮内试验，以及早确诊并治疗。 【关键词】曲霉菌病，变应性支气管肺； 分类； 诊断 [|I1图分类号]R563【义献标识码]A 【文章编号]1008—8296(2008)一01—0033—03 Clinical analysis of 19 cases of allergic brochopulmonary aspergillosis GONG J HU Bi-fie．ZHU Hui—li．LI Xiang一),anq Department of Respiratory Medicine of Zhonqshan Hospital，Fudan University，Shanghai 200032，China 【Abstract J Objective To describe and identify different forms of allergic br0nch0pulm0nary aspergillosis(ABPA)． Methods Ninteen eases patients with ABPA included in the stlldy were divided into two groups：8 patients met the diagnostic Cl’iteria of allergic hronchopuhnonary aspergiUosis—ser0p0sitive(ABPA-S)，and the other patients were diagnosed with ABPA with central hronchiectasis(ABPA-CB)．The clinical presentations、serologic results．hmg flmction data and chest radiology Were analyzed．Results The ninteen cases patients ineluded 1 1 maleft and 8 females．Initial diagnosis was tuberculosis．1ung cancer．asthma．allergic pneumonia and Wegener’s granulomatosis．There was no significant difference in age、gender and clinical presentations between the two groups．Absolute eosinophil count and total IgE of patients in ABPA-CB group were higher than those of patients in ABPA-S group．Conclusions The present observations sugge