基于 2017版《变应性支气管肺曲霉病诊治专家共识》的病例分析
Case analysis based on 2017 version of Expert Consensus on the Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis

目的 ·以中华医学会呼吸病学分会哮喘学组制定的 2017版《变应性支气管肺曲霉病（ allergic bronchopulmonary aspergillosis， ABPA）诊治专家共识》（简称《专家共识》）为依据，分析确诊的 ABPA病例。方法 ·依据《专家共识》，回顾性分析上海交通大学医学院附属瑞金医院 2013年 1月—2017年 12月确诊的 12例 ABPA住院患者的临床资料。结果 · 12例 ABPA患者中，男女各 6例，临床表现为咳嗽、咳痰、气喘等， 10例血清总免疫球蛋白 E（total immunoglobulin E，tIgE）升高， 9例外周血嗜酸性粒细胞升高；7例行过敏原皮试速发反应，其中 3例霉菌阳性； 5例行血清烟曲霉特异性 IgE（specific IgE，sIgE）检测，均升高；胸部 CT多表现为支气管扩张，部分伴黏液栓。完全满足《专家共识》诊断标准的占 50.0%。12例均行皮质激素治疗，其中 9例联合抗真菌药物。结论 · ABPA临床表现多不典型；对于哮喘、支气管扩张等肺病患者，可监测血清 tIgE、烟曲霉 sIgE和嗜酸性粒细胞水平；行过敏原皮试速发反应及影像学检查，有利于提高 ABPA的诊断率；治疗主要为激素联用抗真菌药物。
：Objective · To analyze the cases of ABPA based on 2017 version of Expert Consensus on the Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis (ABPA) (Expert Consensus in short) developedAsthma Group of Chinese Medical Association Respiratory Diseases Society. Methods · According to the Expert Consensus, the clinical data of 12 patients with ABPA admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine January 2013 to December 2017 were retrospectively analyzed. Results · Among the 12 patients with ABPA, 6 were males and 6 were females. The clinical manifestations were cough, having phlegm, short of breath, etc. The total immunoglobulin E (tIgE) in sera of 10 cases increased, and the peripheral blood eosinophils of 9 cases increased. Seven cases underwent the skin test, 3 of whom were positive in aspergillus. Serum aspergillus-specific IgE (sIgE) of all the 5 cases tested was elevated. The most patients showed bronchiectasis in chest CT, and some also with mucus plug. Fifty percent of the cases fully met the diagnostic criteria of Expert Consensus. All the patients were treated with corticosteroid, and 9 of them were also treated with antifungal drugs. Conclusion · The clinical manifestations of ABPA are atypical. For the patients with lung diseases such as asthma and bronchiectasis, serum tIgE, aspergillus sIgE and eosinophil levels need to be monitored. Aspergillus skin test and imaging examination are helpful to the diagnosis of ABPA. The main treatment is the combination of corticosteroid and antifungal drugs