Mou Yan, Ye Ling, Ye Maosong, Yang Dong, Jin Meiling
Department of Respiratory Medicine, Zhongshan Hospital Affiliated with Fudan University, Shanghai, China.
Allergy Asthma Proc. 2014 Mar-Apr;35(2):e21-6. doi: 10.2500/aap.2014.35.3731.
This study was designed to aid health care providers in better understanding the need for earlier recognition of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis (ABPA/ABPM). Patients with a confirmed diagnosis of ABPA/ABPM after evaluation in the Department of Respiratory Medicine of Zhongshan Hospital affiliated to Fudan University between March 2003 and January 2013 were analyzed retrospectively. Clinical signs and symptoms, previous diagnoses and potential diagnostic errors, serologic tests and chest computed tomography (CT) were reviewed and compiled. Seventy patients were diagnosed with ABPA/ABPM in which 52 were misdiagnosed or underdiagnosed. The median total serum IgE level was 2574 IU/mL, ranging from 338 to 31527 IU/mL. Fifty-eight of the 70 patients were tested for specific IgE (sp-IgE) in which 57 were positive to Aspergillus fumigatus and 48 were positive to Penicillium. Twelve of the 70 patients did not undergo sp-IgE testing but allergy skin test, and all were positive to A. fumigatus. The two most common abnormalities found on chest CT exams were central bronchiectasis (CB) and mucus plugs in 48 and 20 patients, respectively. The time from first hospital visit to confirmation of diagnosis for ABPA/ABPM-CB (48/70) was longer than that of ABPA/ABPM-seropositive type (S; 22/70; 30.8 ± 9.81 m versus 9.3 ± 3.55 m; p = 0.044). Prior diagnoses antecedent to our diagnostic conformation included 13 patients with bronchial asthma, 12 with bronchiectasis, and 19 with pneumonia. Only 18 patients were correctly first diagnosed with ABPA/ABPM. ABPA/ABPM is not an uncommon complication accompanying underlying chronic diseases, most notably bronchial asthma and cystic fibrosis. Patients who present with poorly controlled disease, especially with recurrent pulmonary infiltrates, demand the attention of a specialist, the sooner the better to minimize the likelihood of more severe, persistent, and ultimately irreversible pathological changes in large airways. Early treatment of oral corticosteroid with or without antifungal therapy can improve the prognosis. Early testing for ABPA/ABPM along with careful ongoing follow-up is imperative and necessary to prevent or forestall significant future morbidity.
本研究旨在帮助医疗保健提供者更好地理解早期识别变应性支气管肺曲霉病/变应性支气管肺真菌病（ABPA/ABPM）的必要性。对2003年3月至2013年1月在复旦大学附属中山医院呼吸内科评估后确诊为ABPA/ABPM的患者进行回顾性分析。对临床体征和症状、既往诊断及潜在诊断错误、血清学检查和胸部计算机断层扫描（CT）进行了回顾和整理。70例患者被诊断为ABPA/ABPM，其中52例被误诊或漏诊。血清总IgE水平中位数为2574 IU/mL，范围为338至31527 IU/mL。70例患者中有58例进行了特异性IgE（sp-IgE）检测，其中57例对烟曲霉呈阳性，48例对青霉呈阳性。70例患者中有12例未进行sp-IgE检测而是进行了变应原皮肤试验，所有患者对烟曲霉均呈阳性。胸部CT检查中发现的两种最常见异常分别为中心性支气管扩张（CB）和黏液栓，分别见于48例和20例患者。ABPA/ABPM-CB（48/70）从首次就诊到确诊的时间长于ABPA/ABPM血清阳性型（S；22/70；30.8±9.81个月对9.3±3.55个月；p=0.044）。在我们确诊之前的既往诊断包括13例支气管哮喘、12例支气管扩张和19例肺炎。只有18例患者最初被正确诊断为ABPA/ABPM。ABPA/ABPM是一种伴随潜在慢性疾病（最显著的是支气管哮喘和囊性纤维化）的常见并发症。表现为疾病控制不佳，尤其是伴有反复肺部浸润的患者，需要专科医生的关注，越早越好，以尽量减少大气道出现更严重、持续且最终不可逆病理改变的可能性。早期口服糖皮质激素治疗，无论是否联合抗真菌治疗，均可改善预后。对ABPA/ABPM进行早期检测并进行仔细的持续随访对于预防或避免未来严重发病至关重要且必要。
