无哮喘的变应性支气管肺曲霉病一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

邓海霞 , 李平 ,  陈俊文

湖北医药学院附属襄阳市第一人民医院呼吸科（湖北襄阳 441000）;

Corresponding author：

陈俊文, Email: xfyycjw@163.com

Keywords：

变应性支气管肺曲霉菌病; 抗真菌药物; 误治; 随访

DOI：

10.7507/1671-6205.202109017

Video：

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目的报道并分析1例变应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）的临床特点、诊断及治疗方法。方法结合文献资料分析我科2019年诊治的1例ABPA的病例。结果该患者诊断明确，治疗稍有曲折。ABPA常发生于肺部有基础疾病者，尤其是支气管哮喘或囊性纤维化者。临床表现主要是咳嗽、咳痰、喘息、胸闷；实验室检查血清总IgE水平和曲霉特异性IgE水平上升，以及嗜酸性粒细胞数增加；胸部影像学表现为反复的肺部游走性浸润影和中心性支气管扩张等。治疗包括糖皮质激素和抗真菌治疗，对于不能耐受糖皮质激素的患者，抗IgE抗体治疗有益。结论临床上ABPA容易误诊、误治，特别是无哮喘病史时，其诊断更加困难。因此早期诊断和正确治疗可以减少ABPA造成的肺损伤，改善患者的预后。

Citation： 邓海霞, 李平, 陈俊文. 无哮喘的变应性支气管肺曲霉病一例. 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, 张茉沁, 陈希, 等. 变应性支气管肺曲霉病临床特点及基础疾病分析. 中国呼吸与危重监护杂志, 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.	陆海雯, 卫平, 徐金富. 变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展. 中国呼吸与危重监护杂志, 2014, 13(5): 534-536.
8.	王梦雨, 乔艳俊, 王红民. 变应性支气管肺曲霉病26例临床分析. 中国呼吸与危重监护杂志, 2019, 18(3): 231-235.
9.	沈华浩, 孙永昌, 林江涛, 等. 变应性支气管肺曲霉病诊治专家共识. 中华医学杂志, 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, 张茉沁, 陈希, 等. 变应性支气管肺曲霉病临床特点及基础疾病分析. 中国呼吸与危重监护杂志, 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. 陆海雯, 卫平, 徐金富. 变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展. 中国呼吸与危重监护杂志, 2014, 13(5): 534-536.
8. 王梦雨, 乔艳俊, 王红民. 变应性支气管肺曲霉病26例临床分析. 中国呼吸与危重监护杂志, 2019, 18(3): 231-235.
9. 沈华浩, 孙永昌, 林江涛, 等. 变应性支气管肺曲霉病诊治专家共识. 中华医学杂志, 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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无哮喘的变应性支气管肺曲霉病一例

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