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支气管哮喘患者中变应性支气管肺曲霉病的检出及临床特点初步调查 被引量:19

Prevalence of allergic bronchopulmonary aspergillosis in Chinese patients with bronchial asthma
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摘要 目的观察支气管哮喘(简称哮喘)患者中曲霉过敏试验阳性的比例、变应性支气管肺曲霉病(ABPA)的检出比例及ABPA患者的临床及影像学特点。方法选取2010年3—9月在北京大学人民医院门诊就诊的非吸烟成年(≥18岁)哮喘患者200例,行过敏原皮肤点刺试验,血嗜酸粒细胞计数、血清总IgE测定、血清抗烟曲霉、抗多价霉菌特异性IgE测定及影像学检查、肺通气功能测定。结果200例患者中烟曲霉皮肤点刺试验阳性者共11例(5.5%),其中5例患者诊断为ABPA,男2例,女3例,年龄为19~62岁,病程为15—40年。临床上均有咳嗽、喘息等典型哮喘症状,其中4例患者肺功能显著下降,血清总IgE及烟曲霉特异性IgE均明显升高,3例患者血嗜酸粒细胞升高,3例患者胸部cT可见中心性支气管扩张。结论我国ABPA的患病率长期被低估,ABPA患者临床表现与单纯的哮喘难以区分,但病程长,肺功能下降更显著。烟曲霉过敏原皮试和血清总IgE是诊断本病的重要提示指标。 Objective To evaluate the frequency of sensitization to Aspergillus antigens and the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients. Methods Two hundred consecutive non-smoking outpatients with asthma (≥ 18 years ) underwent skin testing with aeroallergens, peripheral eosinophil counting, measurements of total serum IgE level and specific IgE against Aspergillus fumigatus, radiologic investigations and pulmonary function tests. Results Eleven patients (5.5%) had a positive skin reactivity to Aspergillus antigens. Five of these 11 patients (45.5%) met the diagnostic criteria of ABPA, an overall prevalence of 2. 5% (5/200). There were 2 males and 3 females, aging from 19 to 62 years, with a disease duration from 15 to 40 years. All of the patients had asthmatic symptoms such as cough and wheeze. Moderate to severe obstructive ventilatory defect was found in 4 patients. Total serum IgE levels and specific IgE against Aspergillusfumigates were elevated significantly in all the patients, and elevated eosinophil count was found in 3 patients. Three cases were diagnosed as ABPA-CB because of the presence of central bronehiectasis on HRCT. Conclusions The prevalence of ABPA in Chinese patients with asthma was underestimated. Clinical features of ABPA were similar to asthma alone, but with longer duration and more severe lung function defect. Sensitization to Aspergillus, increased eosinophils and total serum IgE levels were important indicators for the diagnosis of ABPA.
作者 马艳良 张为兵 余兵 陈燕文 母双 崔月莉 MA Yan-liang , ZHANG Mei-bing, YU Bing, CHEN Yan-wen, MU Shuang, CUI Yue-li,(Department of Pulmonary and Critical Care Medicine, People' s Hospital, Peking University, Beijing 100044, China)
出处 《中华结核和呼吸杂志》 CAS CSCD 北大核心 2011年第12期 909-913,共5页 Chinese Journal of Tuberculosis and Respiratory Diseases
基金 北京大学人民医院研究与发展基金(RDC2009-16)
关键词 曲霉菌病 变应性支气管肺 哮喘 患病率 Aspergillosis, allergic bronehopulmonary Asthma Prevalence
作者简介 通信作者:马艳良,Email:helloy11979@126.com
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参考文献13

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