無哮喘的變應性支氣管肺曲霉病一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

鄧海霞 , 李平 ,  陳俊文

湖北醫藥學院附屬襄陽市第一人民醫院呼吸科（湖北襄陽 441000）;

Corresponding?author：

陳俊文, Email: xfyycjw@163.com

Keywords：

變應性支氣管肺曲霉菌病; 抗真菌藥物; 誤治; 隨訪

DOI：

10.7507/1671-6205.202109017

Video：

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目的報道并分析1例變應性支氣管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的臨床特點、診斷及治療方法。方法結合文獻資料分析我科2019年診治的1例ABPA的病例。結果該患者診斷明確，治療稍有曲折。ABPA常發生于肺部有基礎疾病者，尤其是支氣管哮喘或囊性纖維化者。臨床表現主要是咳嗽、咳痰、喘息、胸悶；實驗室檢查血清總IgE水平和曲霉特異性IgE水平上升，以及嗜酸性粒細胞數增加；胸部影像學表現為反復的肺部游走性浸潤影和中心性支氣管擴張等。治療包括糖皮質激素和抗真菌治療，對于不能耐受糖皮質激素的患者，抗IgE抗體治療有益。結論臨床上ABPA容易誤診、誤治，特別是無哮喘病史時，其診斷更加困難。因此早期診斷和正確治療可以減少ABPA造成的肺損傷，改善患者的預后。

Citation： 鄧海霞, 李平, 陳俊文. 無哮喘的變應性支氣管肺曲霉病一例. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(8): 583-586. doi: 10.7507/1671-6205.202109017 Copy

1.	Maturu VN, Agarwal R. Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta-analysis. Clin Exp Allergy, 2015, 45(12): 1765-1778.
2.	Ayoubi N, Jalali S, Kapadia N. A case of allergic bronchopulmonary aspergillosis (ABPA) in a patient with a history of cocaine use and tuberculosis. Case Rep Med, 2019, 2019: 3265635.
3.	Oguma T, Taniguchi M, Shimoda T, et al. Allergic bronchopulmonary aspergillosis in Japan: a nationwide survey. Allergol Int, 2018, 67(1): 79-84.
4.	Muthu V, Sehgal IS, Prasad KT, et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: a distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol, 2020, 58(2): 260-263.
5.	公丕平, 張茉沁, 陳希, 等. 變應性支氣管肺曲霉病臨床特點及基礎疾病分析. 中國呼吸與危重監護雜志, 2021, 20(12): 846-852.
6.	Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 2013, 51(4): 361-370.
7.	陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
8.	王夢雨, 喬艷俊, 王紅民. 變應性支氣管肺曲霉病26例臨床分析. 中國呼吸與危重監護雜志, 2019, 18(3): 231-235.
9.	沈華浩, 孫永昌, 林江濤, 等. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
10.	Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013, 43(8): 850-873.
11.	Agarwal R, Sehgal IS, Dhooria S, et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res, 2020, 151(6): 529-549.
12.	Agarwal R. What is the current place of azoles in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. Expert Rev Respir Med, 2012, 6(4): 363-371.
13.	Agarwal R, Garg M, Aggarwal AN, et al. Serologic allergic bronchopulmonary aspergillosis (ABPA-S): long-term outcomes. Respir Med, 2012, 106(7): 942-947.
14.	Agarwal R, Khan A, Aggarwal AN, et al. Role of inhaled corticosteroids in the management of serological allergic bronchopulmonary aspergillosis (ABPA). Intern Med, 2011, 50(8): 855-860.
15.	Agarwal R, Dhooria S, Singh Sehgal I, et al. A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest, 2018, 153(3): 656-664.
16.	Ram B, Aggarwal AN, Dhooria S, et al. A pilot randomized trial of nebulized amphotericin in patients with allergic bronchopulmonary aspergillosis. J Asthma, 2016, 53(5): 517-524.

1. Maturu VN, Agarwal R. Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta-analysis. Clin Exp Allergy, 2015, 45(12): 1765-1778.
2. Ayoubi N, Jalali S, Kapadia N. A case of allergic bronchopulmonary aspergillosis (ABPA) in a patient with a history of cocaine use and tuberculosis. Case Rep Med, 2019, 2019: 3265635.
3. Oguma T, Taniguchi M, Shimoda T, et al. Allergic bronchopulmonary aspergillosis in Japan: a nationwide survey. Allergol Int, 2018, 67(1): 79-84.
4. Muthu V, Sehgal IS, Prasad KT, et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: a distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol, 2020, 58(2): 260-263.
5. 公丕平, 張茉沁, 陳希, 等. 變應性支氣管肺曲霉病臨床特點及基礎疾病分析. 中國呼吸與危重監護雜志, 2021, 20(12): 846-852.
6. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 2013, 51(4): 361-370.
7. 陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
8. 王夢雨, 喬艷俊, 王紅民. 變應性支氣管肺曲霉病26例臨床分析. 中國呼吸與危重監護雜志, 2019, 18(3): 231-235.
9. 沈華浩, 孫永昌, 林江濤, 等. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
10. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy, 2013, 43(8): 850-873.
11. Agarwal R, Sehgal IS, Dhooria S, et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res, 2020, 151(6): 529-549.
12. Agarwal R. What is the current place of azoles in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. Expert Rev Respir Med, 2012, 6(4): 363-371.
13. Agarwal R, Garg M, Aggarwal AN, et al. Serologic allergic bronchopulmonary aspergillosis (ABPA-S): long-term outcomes. Respir Med, 2012, 106(7): 942-947.
14. Agarwal R, Khan A, Aggarwal AN, et al. Role of inhaled corticosteroids in the management of serological allergic bronchopulmonary aspergillosis (ABPA). Intern Med, 2011, 50(8): 855-860.
15. Agarwal R, Dhooria S, Singh Sehgal I, et al. A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest, 2018, 153(3): 656-664.
16. Ram B, Aggarwal AN, Dhooria S, et al. A pilot randomized trial of nebulized amphotericin in patients with allergic bronchopulmonary aspergillosis. J Asthma, 2016, 53(5): 517-524.

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無哮喘的變應性支氣管肺曲霉病一例

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